Most of us have relied on antibiotics at some point. But, for all the help they provide, are some doing more harm than good?
Last week, the Government ordered GPs to cut antibiotic use by 15 per cent to battle the spread of drug-resistant superbugs.
However, that’s not the only problem some antibiotics can cause. One class — known as quinolones and fluoroquinolones — is commonly used to treat everything from chest infections to urinary tract bugs.
Ciprofloxacin, a fluoroquinolone, is the most prescribed of these. Others include levofloxacin, moxifloxacin and norfloxacin.
Less is more: Last week, the Government ordered GPs to cut antibiotic use by 15 per cent to battle the spread of drug-resistant superbugs
GPs like the fact they can tackle a wide range of bacteria. In 2017, it’s estimated that more than 675,000 quinolones and fluoroquinolones were dispensed by GPs and other practitioners in England alone, and about the same amount again in hospitals.
But there have been claims the drugs can have devastating side-effects, such as tendon rupture, joint problems and nerve pain. It’s thought that because fluoroquinolones act on the mitochondria (powerhouses in cells responsible for releasing energy), effects can be felt all over the body, sometimes permanently.
Laboratory research also suggests the drugs can provoke a reaction specifically in tendon cells, producing enzymes that cause the tendon to break down.
As Good Health has reported, UK campaigners have been battling for years to raise awareness and for authorities to acknowledge the extent of the risk to patients.
Back in October, the European Medicines Agency (EMA), which oversees regulation across the EU, imposed new restrictions on the drugs’ use. It said they should only be used when ‘there are no alternatives’, with better education for doctors on the risks and improved care for patients struck with adverse reactions.
However, the campaign group, Quinolone Toxicity Support UK, says these recommendations fall short of what’s needed. ‘It doesn’t go anywhere near far enough,’ says Miriam Knight, who helped set up the group in 2015. ‘If anything, it’s a step backwards.
‘The patient information leaflets for these drugs already state that side-effects such as ruptured tendons and nerve damage are “rare”.
Estimate: In 2017, it’s estimated that more than 675,000 quinolones and fluoroquinolones were dispensed by GPs and other practitioners in England alone
‘The wording of the EMA recommendation describes them as “very rare”, which means doctors are, if anything, even less likely to take the risks seriously.’
The campaigners believe that the EMA and the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK have made a fundamental mistake by basing the new restrictions on adverse drug reactions reported through the Yellow Card Scheme.
From 1990 to 2018, there were nearly 11,000 adverse reactions and 107 deaths reported in the UK for ciprofloxacin — one of the most common fluoroquinolones.
But even the MHRA acknowledges as little as 10 to 15 per cent of serious adverse drug reactions are reported through the scheme — so it could mean the real figure is in excess of 100,000 people. Campaigners fear telling doctors adverse reactions are ‘very rare’ means they’re unlikely to consider the drugs as a cause when they see patients with problems such as ruptured tendons after having been treated for a chest infection.
‘We are not calling for a complete ban on the drugs,’ says Miriam Knight. ‘We believe there should be clearer warnings about the risks.’
German authorities are considering a ban, apart from in exceptional circumstances, and, in the U.S., the Food and Drug Administration has issued five warnings to doctors over the past decade, since alerting them to the risk of serious side-effects, including ruptured Achilles tendons and the latest, in July last year, the risk of mental health problems and hypoglycaemia — a dangerous drop in blood sugar in people with diabetes.
There is also evidence certain genetic deficiencies might leave some patients more at risk.
One such defect is G6PD, an enzyme involved in cellular energy production, which can be detected with a blood test. Miriam Knight says patients should be screened for this and tracked for side-effects for five years afterwards.
In 2013, Jane Allan, 50, a mother of two from Romford, Essex, fell ill within days of taking ciprofloxacin for a chest infection, with excruciating burning pain in her joints, bones and muscles.
Five years on, she is still in frequent pain and has had to give up work as a hospital pharmacist because of it.
Jane was bitterly disappointed by the EMA review. ‘This recommendation is pathetic and should have gone much further,’ she told Good Health. ‘These drugs should always be the last line of defence. My life has been changed for ever, and I am not alone.’
However, Neal Millar, a consultant orthopaedic surgeon and lecturer in immunology at the University of Glasgow, who gave evidence at the hearing, says the EMA’s wording is as strong as anyone could realistically expect.
Yet he, too, was disappointed by its failure to include advice to GPs to always urgently refer patients affected by these antibiotics to specialists. ‘A lot of these patients come to us up to two years after side-effects started,’ he says. ‘GPs often fail to acknowledge these patients need specialist help.’