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martes, 2 de agosto de 2016

Reasons to avoid fluoroquinolones


PulmCrit (EM Crit)
PulmCrit - August 1, 2016 - By Josh Farkas 
"In fairness, fluoroquinolones are generally very effective and toxicity is uncommon. In situations where fluoroquinolones are the best antibiotic choice, they should certainly be used. My objection to fluoroquinolones isn’t that they are evil, but rather that better alternatives usually exist in the ICU. The utility of fluoroquinolones is probably greater among outpatients, among whom many of the above considerations are less pertinent.

Fluoroquinolones generally aren’t very useful among critically ill patients for several reasons:
  1. Resistance impairs the ability to use fluoroquinolones as monotherapy for sepsis.
  2. Fluoroquinolones add very little to beta-lactams, making “double-coverage” with a fluoroquinolone ineffective.
  3. Fluoroquinolones are notable for their ability to breed multi-drug resistant organisms and clostridium difficile.
  4. Most patients with a “penicillin allergy” can be safely treated with a third- or fourth-generation cephalosporin, rather than fluoroquinolone.
  5. Fluoroquinolones block GABA receptors and stimulate NMDA receptors, which may cause delirium and seizure.
  6. The FDA recently released a boxed warning that fluoroquinolones can cause a persistent, debilitating peripheral neuropathy."