
When antibiotics turn toxic - car
https://www.nature.com/articles/d41586-018-03267-5
======
rewgs
I worked all my life to attend my dream music school, and once there things
went even better than expected. Big things were happening, and bigger things
were on the horizon.

I took one dose of Cipro and developed permanent tendinosis. My career was
ruined. On top of the tendon damage, my nerves were on fire for about three
years, and I went from being extremely mentally sharp to pretty foggy with
trouble concentrating or multitasking. Though I can't prove the extent of its
reach, I went from being an extremely healthy person to someone plagued by
seemingly mysterious health issues -- many ususally found in people twice my
age or more -- for years, and my best guess to this day is that damn drug.

Cipro robbed me of my career, my identity, and my 20s. I've never quite fully
recovered or found a job I loved as much/was as good at as playing guitar.

Fuck Cipro.

~~~
manuisin
I'm sorry that was your experience, but that's just one side. 4 doctors told
me to take it less than a month ago.

Cipro saved my life.

My only side-effect is that it left me with not being able to eat anything
heavy. I can only digest something like Soylent now, so happy that Soylent is
a thing otherwise life would suck.

~~~
sgift
And, unfortunately, both results are in the expected spectrum. They may even
be at the same time. The list of side effects on the medications I have to
take is longer than my arm written in a small font and I hope every day that I
don't start to get any of them. I still take the medications, because when I
don't do it my life gets bad pretty fast, but the thought always lingers "what
if ..?"

~~~
zaarn
The list of side effects is quite long because they write anything on there.

My Ibuprofen bypackage lists "severe intestinal bleeding, shock, cardiac
arrest and coma" at the bottom "less than 1 in 10 million" (IIRC that was the
category).

There is a youtube channel that details some of these mishaps and a recent
episode detailed someone who took anti-depressants, which lead to being unable
to sleep and that person taking sleep drugs in response. Which eventually
cause her colon to explode because the drugs in conjunction stopped almost all
stomach movement (She survived but her colon was removed due to extensive
necrosis).

Medicine/Drugs is always a risk game. There is always a chance that a simple
appendectomy goes sour and you die on the operating table. Or that a
vaccination leads to a fatal infection at the puncture site. Usually medical
professionals try to play it safe and the actual risk for any individual is
very low or as low as it can safely be made.

If it goes sour, it can go sour really fast, which is why IMO it's important
that you speak with a professional instead of self-medicating for anything
beyond cough drops and headache pills atleast once to ask if you can safely
take it (even if they disagree that taking is necessary), especially when you
already take other medication.

------
jglauche
They gave me ciprofloxacin for about 4 days without knowing after surgery.
Every day in, my ADHD symptoms got worse, my psych medication was less
effective and my pain levels increased to a point I noted down 10/10 in my
notebook + that page looks like I am a mad lady having a total breakdown. One
and a half day later, after I got switched to another class of antibiotics my
pain levels dropped to 3-4/10 and I could focus better. This happened
suddenly, like someone flipped a switch in my head.

On an earlier occasion I was making detailed suicide plans the second week in
on ciprofloxacin, which resolved itself shortly after discontinuation.

It has not caused permanent damage to me but this I have to list it as
"allergy" for doctors not to prescribe it to me. I had problems doctors not
believing the mental issues that this antibiotic cause.

------
gerbilly
I suffered tendon damage and other side effects after taking Cipro.

Believe me, the reports of side effects are _real_.

It took me about 2 years to recover, and probably only because I had a mild
case.

God help those pour souls who have a severe case.

To this day if I go back and read the 'floxie' forums it makes me feel blue
for the rest of the whole day.

For every person that recovers, it seems like two new cases appear on the
forums.

Also, there are many parallels between FQ toxicity and so called 'Gulf War
Syndrome'. The soldiers were ordered to take the stuff for months on end to
protect against Anthrax attacks.

------
jobenjo
I had a single pill of levofloxin about three years ago (for pneumonia). I
woke up the next day, barely able to walk, with mass tendonopathy (tendon
loss) in my arms and legs. I did the research and found out the dangers
immediately, but one pill was enough to cause massive damage for me. My
recovery took about ~2 years and was slow and challenging, but I'm now part of
a facebook group where I see I'm one of the lucky ones. Many people have
horrible symptoms and aren't recovering years out. New people join daily.

~~~
mattigames
The most worrying part is probably that they gave you a full pill; it seems
that something so likely to fail should be given as a microdose to check if
its well tolerated by the patient.

~~~
jobenjo
In the future, I hope there's a blood test to check for susceptibility...
There is already talk of a gene that many people who get fluoroquinolone
toxicity have in common.

------
lkrubner
It's interesting to read these stories and realize how different each person's
biology is. I took Cipro every day for an entire year and I had no ill effects
except in the summer I got a very bad sun burn. Reading these other stories,
and considering my own good luck, makes me think we need better tests to see
if people have any sensitivity to these drugs, before they take large amounts.

------
tvanantwerp
I was recently prescribed levofloxacin. Within 12 hours, I started having
intermittent pins and needles sensations. Rather than soldier through it, I
thankfully looked up the symptoms and discovered what terrible damage
fluoroquinolones can do. I got off of those antibiotics immediately, and I'm
paying close attention for any delayed symptoms. Thankfully the peripheral
neuropathy has gone.

When prescribed, I was given no warnings. Not even a pamphlet with tiny print.
When I returned to the pharmacists with my complaints and research, they were
literally Googling it--they had no idea about the FDA warnings.

~~~
gumby
> When prescribed, I was given no warnings. Not even a pamphlet with tiny
> print.

That's malpractice by your pharmacist. In my state they are required to give
you the "label" (that handout) and discuss the drug with you if you haven't
been prescribed it before.

> When I returned to the pharmacists with my complaints and research, they
> were literally Googling it--they had no idea about the FDA warnings.

This is even _more shocking._ If you're not exaggerating, you really should
call the pharmaceutical licensing agency and the attorney general's office
(who will send to the right agency for your state). Your pharmacy has
unqualified people who are putting lives at risk. If they don't even know
these basics who knows what other errors they are making?

I am not kidding about calling the authorities. I don't like the "self-
righteous complainers" but this is a genuine public health risk.

FWIW I studied for a pharmaceutical license (but thankfully didn't have to
take it as it became obvious to all of us that we shouldn't cut that corner
and instead should hire an in-house pharmacist experienced with drug
development)

~~~
tvanantwerp
Unfortunately I was vacationing in Hong Kong when all of this happened, and I
suspect the laws there are much looser or non-existent.

------
ggm
Due to a toxic reaction I'm advised to avoid rulide class antibiotics. When I
mention this to medical people they often frown, once they've gone into the
web equivalent of the PDR. They seem to take longer to find something to use.

My take-away from this, is that once you know you can't take a family of
antibiotics you've "walked off the reservation" for standard treatment
guidelines and made their job harder in ways which can potentially go to
equally bad outcomes for you. Do they have a competent alternative? Whats the
implications of moving up the drug "defcon" chart to something stronger?

Its not win-win to know you can't take a drug, its possibly lose-lose.

Not that there is an alternative. I'm just saying, that empowerment with
knowledge you can't take eg Cipro has a consequence bigger than just "don't
take Cipro"

------
andrewl
I won't take _any_ fluoroquinolone antibiotics. I had terrifying mental
effects after one dose (not one course, one _pill_ ) of Avelox (Moxifloxacin).
Fortunately I had no permanent effects. I had a similar, but less severe,
reaction to Cipro.

Some time later I rejected a prescription of Levofloxacin, and asked my
physician for Doxycycline, which I tolerate well. I discussed it with my
pharmacist and she agreed with my decision. She had taken Levofloxacin for a
few days three years earlier and it gave her permanent (so far) neuropathy in
hip and leg, and balance problems.

This 2016 posting includes discussion of Cipro and other drugs in this class:

[https://news.ycombinator.com/item?id=13273770](https://news.ycombinator.com/item?id=13273770)

Here are some relevant articles:

Fluoroquinolone-Induced Serious, Persistent, Multisymptom Adverse Effects.
_BMJ Case Reports_ , 2015:

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4600819/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4600819/)

Levofloxacin-Induced Acute Psychosis. _Indian Journal of Psychiatry_ , 2008:

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2745871/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2745871/)

American Academy of Family Physicians (AAFP) warning:

[https://www.aafp.org/news/health-of-the-
public/20160727fluor...](https://www.aafp.org/news/health-of-the-
public/20160727fluoroquinolones.html)

------
Udik
I took levofloxacin for a week about two years ago, for a very annoying
infection that had lasted for months. The infection just disappeared within
one or two days, and I didn't get any side effects. Writing this here just to
add some "negative" report- I wonder how many of the hundreds who are reading
this thread took a fluoroquinolone in the past and simply have nothing bad to
report. Still, to be clear, I wouldn't take it again, but the probabilities of
getting serious damage are probably rather low.

------
avgDev
I was given cipro 7 years ago at a hospital...instant terrible allergic
reaction, rash, flashing lights in eyes and tinnitus.

I was released from the hospital the day after. Nothing reported to the FDA,
barely a mention of a reaction in the paperwork. I was too young to pursue any
legal action.

Then over the course of 6 months my health deteriorated. Insomnia, joints
started to click, got floaters in my vision. Then clicking turned into joint
pain. Also, got nerve buzzing, frequent headaches, IBS, frequent heartburn.
There was a time when I could not walk for weeks. Doctors would simply give up
and give very little help just pain meds. Mayo clinic diagnosed my tendon
issues as tendon overuse because I was athletic prior.....

I work now and can push myself to do many things. I manage the issues quite
well and I would say it is a bit better than 7 years ago. However, fuck the
medical community, I swear I have seen close to 100 doctors over the course of
the last few years from Mayo, Rush, Northwestern and more and only two doctors
agreed that it could be Cipro. One doctor refused to note it in my paperwork,
and suggested to wait it out as it should get better. Later I found out he is
an expert witness for pharma....

As someone that has researched problems since I was little.....I just cannot
accept that people with a PhD can be that fucking terrible at typing "cipro
tendon" into google search bar and reading studies, stories, and the black
label. Or doctors are too much in debt and worry about the risk of going
against the medical community. I don't know. The system is simply broken,
these issues are under reported as symptoms can show up to 12 months after
last dose. Doctors don't report shit and won't even ask if you took fqs.

Interesting fact is that many UTIs are treated with fluoroquinolones. 90% of
people diagnosed with fibromyalgia( I have received this diagnosis a few
times) are women. They also get diagnosed with UTIs a lot more than men.

------
kpozin
Be aware that not having a reaction the first time(s) you take
fluoroquinolones is no guarantee that it won't happen later.

I had had several exposures to levofloxacin (a very bad ear infection) and
ciprofloxacin (post-surgery prophylaxis) several years apart and was fine. A
few months after that latter exposure, I took one dose of levofloxacin for an
apparent infection, and within less than a day I started experiencing pain in
one and then the other ankle. It was very painful to walk for about a month,
my ankles were creaky and sore, and there was transitory soreness in my wrists
as well. The acute pain subsided after that month but it took about five
months total before my ankles were completely pain-free.

Don't use these antibiotics except to treat something that will kill you
otherwise.

------
notabee
This was a study that caught my attention recently:

[https://jamanetwork.com/journals/jamasurgery/article-
abstrac...](https://jamanetwork.com/journals/jamasurgery/article-
abstract/2689031)

Cipro greatly increased the rate of aortic aneurysm/dissection in mice when
they were challenged with high blood pressure. The examination goes into
detail about the reasons. Essentially the drug both inhibits connective tissue
repair and starts degrading it. So the black box warning is about tendons, but
there's connective tissue all over the body (like in the aorta). There's
probably a subset of individuals more genetically susceptible to the
disruption, but it looks like this could worsen lots of latent issues in just
about anyone.

------
delbel
this article isn't about antibiotics, it is about a specific class of
antibiotics called fluoroquinolones. This overly broad simplification, it's
like saying all cars are bad because one manufacturer's specific line of cars
is prone to a failure. That doesn't mean we stop driving all cars. We address
that specific manufacture and specific line of cars.

~~~
genomer
The article didn't focus solely on quins.

An example of a different class: "Researchers have shown, for example, that
aminoglycoside antibiotics can cause deafness by damaging mitochondria in the
hair cells of the ear."

More general statement: "They reported that antibiotics in several classes
triggered oxidative stress — a build-up of reactive, oxygen-containing
molecules — in mitochondria, inhibiting their function across a range of
mammalian cells, as well as in mice."

I interpreted the article as saying that quins are the most obvious example of
antibiotics causing harm, but one example for where they cause harm
(mitochondria) is a problem shared by other antibiotics. Unfortunately there
isn't a test for evaluating mitochondrial damage in the body. Since we can't
test, we don't know the real extent of damage done by any antibiotic to human
cells. More research is needed.

------
gordo4
fluoroquinolones are nasty stuff... should be reserved for extreme cases, like
anthrax poisoning, etc... where the benefits outweigh the cons.

~~~
Fomite
And this is starting to take place - reducing fluroquinolones are one of the
major cornerstones of antibiotic stewardship programs.

One of the problem is that they also work _really_ well. A broad spectrum
bactericidal antibiotic that works really well, isn't in the beta-lactam
family (dodging both beta-lactam resistance and penicillin allergies) is _very
tempting_ to use.

It's a hard fight, especially in the outpatient setting, because of this.

------
darkerside
The FDA must certainly have studied this drug before approving it for use on
the general public. Is there somewhere we can view records and details of the
studies that were performed?

~~~
refurb
Look at the Prescribing Information. It lists the clinical data that was the
basis for approval.

------
growlist
My opinion: these drugs are dangerous, and should only be used as an absolute
last resort. I had the common reaction of damage to connective tissue - my
tendons became painful and weak all over my body, to the point that at one
point it was difficult even to walk. I couldn't sit in a chair because the
pressure on my hamstrings was so painful. Also my skin thinned all over my
body to the point where I was nicking through the skin on my palms every 5
minutes whilst gardening. Thankfully my tendons and skin have recovered
somewhat, but are not what they were. I also have chronic reflux issues that
came on at the same time, and which I strongly suspect are related to Cipro.
I'll repeat my advice to add to all the others: do not take these drugs unless
the alternative is horrific!

------
rl3
A family member of mine ended up with permanent peripheral neuropathy in their
feet within days from taking a fluoroquinolone-class antibotic for something
that wasn't even that serious. They were old enough that remyelination
wouldn't occur, and it didn't. Still can't feel their feet to this day, and it
happened a decade ago.

Funny enough I was prescribed a fluoroquinolone a few months back without even
asking; the condition was so benign that using it was left up to me as
optional. The risk calculus there was unfathomably bad, and suffice it to say
I didn't take any.

------
novon
Same sad story here, 2 doses of Cipro and joints were gone for 6 months.
Antioxidants and topical magnesium oil helped. What a nightmare of a drug.

------
hycaria
Still not enough for MDs to keep fluoroquinolones for threatening conditions
or resistant infections it seems. Incredible. Tons of molecules can and SHOULD
be used first in most cases described here. It's just so bad. Someday we will
have nothing left against bacteria and this will be entirely deserved.

------
pkaye
A lot of anitbiotics are ototoxic (damage to hearing) or nephrotoxic
(kidneys).

------
billybob098
The article doesn't even mention gut flora. Aren't they considering that the
systemic degeneration is caused by the damage the antibiotics inflict to the
gut microbiome?

~~~
genomer
Directly from the article.

"Until recently, investigations into the side effects of antibiotics have
focused on how the drugs disrupt the human microbiome, says James Collins, a
medical engineer at the Massachusetts Institute of Technology in Cambridge."

~~~
billybob098
*barely even mentions

------
abdulhaq
Just for counterpoint, Cf, hlt, kidney tx, amoxicillin, fluclox,
gentamicin,azlocillin, ceftazidime, vancomycin, you name it... Loving cipro
these days

------
DoreenMichele
Related:

[https://news.ycombinator.com/item?id=17831003](https://news.ycombinator.com/item?id=17831003)

