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更新时间:2020-2-24 8:09:39 来源:本站原创 作者:佚名 浏览:

Popular Antibiotics May Carry Serious Side Effects

Antibiotics are important drugs, often restoring health and even saving lives. But like all drugs, they can have unwanted and serious side effects, some of which may not become apparent until many thousands of patients have been treated.


Such is the case with an important class of antibiotics known as fluoroquinolones. The best known are Cipro (ciprofloxacin), Levaquin (levofloxacin) and Avelox (moxifloxacin). In 2010, Levaquin was the best-selling antibiotic in the United States.


But by last year it was also the subject of more than 2,000 lawsuits from patients who had suffered severe reactions after taking it.


Part of the problem is that fluoroquinolones are often inappropriately prescribed. Instead of being reserved for use against serious, perhaps life-threatening bacterial infections like hospital-acquired pneumonia, these antibiotics are frequently prescribed for sinusitis, bronchitis, earaches and other ailments that may resolve on their own or can be treated with less potent drugs or nondrug remedies - or are caused by viruses, which are not susceptible to antibiotics.


In an interview, Mahyar Etminan, a pharmacological epidemiologist at the University of British Columbia, said the drugs were overused "by lazy doctors who are trying to kill a fly with an automatic weapon."

在接受采访时,英属哥伦比亚大学(University of British Columbia)的药理流行病学家玛赫亚·埃特米南(Mahyar Etminan)说这类抗生素被滥用,“开药的医生太懒,他们打算用自动武器来杀死一只苍蝇。”

Dr. Etminan directed a study published in April in The Journal of the American Medical Association showing that the risk of suffering a potentially blinding retinal detachment was nearly fivefold higher among current users of fluoroquinolones, compared with nonusers. In another study submitted for publication, he documented a significantly increased risk of acute kidney failure among users of these drugs.

埃特米南主导的一项研究,其报告已刊登在今年四月的《美国医学会杂志》(The Journal of the American Medical Association)上,报告指出在现有使用氟喹诺酮的病人中,发生视网膜脱落导致眼盲的风险,是不用该类药物的人群的近五倍。他做的另一项研究已经投稿,研究发现使用这类抗生素的患者发生急性肾衰竭的可能性出现了显著提高。

The conditions Dr. Etminan has studied are relatively easy to research because they result in hospitalizations with diagnoses that are computerized and tracked in databases. Far more challenging to study are the array of diffuse, confusing symptoms suffered by fluoroquinolone users like Lloyd Balch, a 33-year-old Manhattan resident and Web site manager for City College of New York.

埃特米兰医生所关注的这些病症相对要容易研究些,因为这些病人已入院治疗,而且诊断结果已记录联网,可以通过数据库来查找。远比他的研究更具挑战性的,是要去厘清使用了氟喹诺酮类药物的患者所出现的一系列混乱、让人迷惑的症状,在33岁的曼哈顿居民、纽约城市学院(City College of New York)网站主管洛伊德·巴尔切(Lloyd Balch)身上,就出现了这种事情。

In an interview, Mr. Balch said he was healthy until April 20, when a fever and cough prompted him to see a doctor. Nothing was heard through a stethoscope, but a chest X-ray indicated a mild case of pneumonia, and he was given Levaquin. Although he had heard of problems with Levaquin and asked the doctor if he might take a different antibiotic, he was told Levaquin was the drug he needed.


After just one dose, he developed widespread pain and weakness. He called to report this reaction, but was told to take the next dose. But the next pill, he said, "eviscerated" him, causing pain in all his joints and vision problems.


Debilitating Side Effects


In addition to being unable to walk uphill, climb stairs or see clearly, his symptoms included dry eyes, mouth and skin; ringing in his ears; delayed urination; uncontrollable shaking; burning pain in his eyes and feet; occasional tingling in his hands and feet; heart palpitations; and muscle spasms in his back and around his eyes. Though Mr. Balch's reaction is unusual, doctors who have studied the side effects of fluoroquinolones say others have suffered similar symptoms.


Three and a half months after he took that second pill, these symptoms persist, and none of the many doctors of different specialties he has consulted has been able to help. Mr. Balch is now working with a physical therapist, but in a phone consultation with Dr. David Flockhart, an expert in fluoroquinolone side effects at the Indiana University School of Medicine, he was told it could take a year for his symptoms to resolve, if they ever do disappear completely.

在巴尔切服用第二粒左氧氟沙星三个半月后,这些症状仍然连绵不去,他看过各科专家,可是没有一个人能改善这些问题。巴尔切现在在接受一位理疗师的帮助,他也电话咨询了印第安纳大学医学院(Indiana University School of Medicine)大卫·弗洛克哈特(Dr. David Flockhart)医生,对方是一位研究氟喹诺酮副作用的专家,结果得知,如果他身上的这些症状真的有可能完全消失的话,也要经过一年时间。

Guidelines by the American Thoracic Society state that fluoroquinolones should not be used as a first-line treatment for community-acquired pneumonia; it recommends that doxycycline or a macrolide be tried first. Mr. Balch didn't know this, or he might have fought harder to get a different antibiotic.

美国胸科学会(American Thoracic Society)给出的指引中明确表明,氟喹诺酮类药物不应是用于治疗在社区感染的肺炎的一线药物;该学会推荐首先使用强力霉素或大环内酯类抗生素(前者为四环素类药,后者的常用药物为红霉素、阿奇霉素等。——编注)。巴尔切并不知道这一点,否则他可能会更加努力争取让医生换药。

Adverse reactions to fluoroquinolones may occur almost anywhere in the body. In addition to occasional unwanted effects on the musculoskeletal, visual and renal systems, the drugs in rare cases can seriously injure the central nervous system (causing "brain fog," depression, hallucinations and psychotic reactions), the heart, liver, skin (painful, disfiguring rashes and phototoxicity), the gastrointestinal system (nausea and diarrhea), hearing and blood sugar metabolism.

氟喹诺酮类药物产生的不良反应可能会出现在身体各处。它的副作用会偶见于肌肉骨骼系统、视觉和肾脏系统,但在极少数情况下,也有可能会对中枢神经系统(导致“脑雾”[brain fog]、抑郁、幻觉和精神病症状)、心脏、肝脏、皮肤(疼痛、难看的皮疹和光毒反应)、胃肠道(恶心、腹泻)、听力以及血糖代谢产生严重损害。

The rising use of these potent drugs has also been blamed for increases in two very serious, hard-to-treat infections: antibiotic-resistant Staphylococcus aureus (known as MRSA) and severe diarrhea caused by Clostridium difficile. One study found that fluoroquinolones were responsible for 55 percent of C. difficile infections at one hospital in Quebec.


Fluoroquinolones carry a "black box" warning mandated by the Food and Drug Administration that tells doctors of the link to tendinitis and tendon rupture and, more recently, about the drugs' ability to block neuromuscular activity. But consumers don't see these highlighted alerts, and patients are rarely informed of the risks by prescribing doctors. Mr. Balch said he was never told about the black-box warnings.

按照美国食品药物监督管理局(Food and Drug Administration,简称FDA)的规定,所有氟喹诺酮类抗生素的产品包装上都必须加注“黑盒子”警告(“black box”是FDA所发出的最严厉的警告。——编注),提醒医生该类药物可能导致病人罹患肌腱炎或者肌腱断裂,近期研究还显示它有神经肌肉阻滞的作用。但消费者并没有注意到这些显眼的警告,开处方的医生也几乎不会向病人告知这类药物的危险。巴尔切说,他的医生从来没告诉他有什么黑盒子警告。

Lack of Long-Term Studies


No one knows how often serious adverse reactions occur. The F.D.A.'s reporting system for adverse effects is believed to capture only about 10 percent of them. Complicating the problem is that, unlike retinal detachments that were linked only to current or very recent use of a fluoroquinolone, the drugs' adverse effects on other systems can show up weeks or months after the treatment ends; in such cases, patients' symptoms may never be associated with prior fluoroquinolone therapy.


No long-term studies have been done among former users of these antibiotics. Fibromyalgia-like symptoms have been associated with fluoroquinolones, and some experts suggest that some cases of fibromyalgia may result from treatment with a fluoroquinolone.


A half-dozen fluoroquinolones have been taken off the market because of unjustifiable risks of adverse effects. Those that remain are undeniably important drugs, when used appropriately. But doctors at the Centers for Disease Control and Prevention have expressed concern that too often fluoroquinolones are prescribed unnecessarily as a "one size fits all" remedy without considering their suitability for different patients.

由于可能产生不必要的严重副作用,有数种氟喹诺酮类抗生素已经禁止销售。那些仍然在使用的药物无疑非常重要,但前提是要使用得当。美国疾病控制中心(Centers for Disease Control and Prevention)的医生们已经对滥用氟喹诺酮表示顾虑,他们指出医生在开药时没有考虑到是否适合不同的患者,不必要地采用了“一刀切”的治疗方案。

Experts caution against giving these drugs to certain patients who face higher than average risks of bad reactions - children under age 18, adults over 60, and pregnant and nursing women - unless there is no effective alternative. The risk of adverse effects is also higher among people with liver disease and those taking corticosteroids or nonsteroidal anti-inflammatory drugs.


When an antibiotic is prescribed, it is wise to ask what the drug is and whether it is necessary, what side effects to be alert for, whether there are effective alternatives, when to expect the diagnosed condition to resolve, and when to call if something unexpected happens or recovery seems delayed.


At the same time, when an antibiotic is appropriately prescribed, it is extremely important to take the full prescription as directed and not to stop treatment when the patient simply begins to feel better.