Peripheral Neuropathy Associated With Cipro

dverse effects associated with the use of ciprofloxacin (Cipro) and other fluoroquinolone antibiotics are not always benign. Not infrequently, they can be severe and permanently disabling, and they may occur following just one or a few doses, according to a study posted on the Annals of Pharmacotherapy Web site. Scheduled for publication in December 2001, this article was released early online because of the threat of anthrax and subsequent heightened interest in Cipro.

Jay S. Cohen, MD, an associate professor of family and preventive medicine at the University of California, San Diego, analyzed 45 cases in which fluoroquinolone antibiotics (including 11 cases involving ciprofloxacin) were associated with adverse effects involving the peripheral nervous system such as tingling, numbness, burning pain, twitching, or spasms. Of those 45 cases, 42 (93%) of these patients also sustained adverse effects involving other systems. Seventy-eight percent experienced central nervous system (CNS) symptoms such as dizziness, agitation, impaired cognitive function, or hallucinations, and 73% reported musculoskeletal symptoms such as joint or muscle pain or tendon rupture. Adverse events also involved the cardiovascular and gastrointestinal systems, skin, and special senses in 18%-42% of cases.

Assessments of severity revealed 2 cases that were mild (4%), 7 moderate (16%), and 36 severe (80%) with chronic pain and/or significantly limited normal function. Symptoms were typically long-term, with 91% exceeding 1 month in duration, 71% exceeding 3 months, and 58% exceeding 1 year. Twelve cases (27%) lasted longer than 2 years. These severe, long-term reactions occurred in a generally young and healthy population. The average patient age was 42 years (range, 11-68 years). Sixty-two percent had no other medical disorder except the infection (mainly sinusitis, prostatitis, urinary infections) that prompted fluoroquinolone therapy.

Because of the current anthrax threat and the hoarding of ciprofloxacin by thousands of people, it is imperative that physicians and the public understand the benefits and potential risks of using ciprofloxacin or other fluoroquinolone antibiotics indiscriminately. The media have, generally, presented only a few fluoroquinolone adverse effects, which are usually described as mild and brief. There are anecdotal reports of people already taking ciprofloxacin prophylactically.

The cases presented in this article, as well as previously published articles about the adverse effects of fluoroquinolones, should give physicians pause before using fluoroquinolones unnecessarily, especially because other, safer antibiotics (eg, penicillin, doxycycline) can often be used instead. Moreover, not all serious reactions associated with fluoroquinolones are listed in package inserts or the Physicians' Desk Reference.

Patients must be informed that with the development of any musculoskeletal, or peripheral or central nervous system symptoms, fluoroquinolone treatment should be discontinued immediately unless medical circumstances (eg, severe infection and no alternative treatment) warrant otherwise. Patients sustaining these reactions should not receive fluoroquinolone antibiotics in the future.