ME Association: Dr Shepherd provides an update on antibiotic use in M.E. and highlights concerns about quinolones and fluroquinolones

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ME Association: Dr Shepherd provides an update on antibiotic use in M.E. and highlights concerns about quinolones and fluroquinolones

http://www.meassociation.org.uk/201...-quinolones-and-fluroquinolones-26-july-2018/

By Dr Charles Shepherd, Hon. Medical Adviser, ME Association.

In view of some of the confusing and incorrect information about the use of antibiotics in M.E., especially where someone develops an unrelated infection, we have produced some basic information on this subject.

General considerations

This information also covers the current concerns relating to the use of one specific group of antibiotics – quinolones and fluroquinolones – and their potential to cause side-effects involving the muscles and tendons.

Provided antibiotics are used correctly, they are normally a safe and effective way of dealing with infections that require their use.

And, as infections are an important cause of relapse in ME/CFS, the prompt use of an antibiotic would be entirely appropriate if someone with ME/CFS has an infection that is likely to respond to an antibiotic…
 
This is really helpful. Thank you Dr Shepard.

Just wondering - are any of the antimalarials related to this class of antibiotic? I know doxycycline is an antibiotic but don't know if it's related. Probably not - just an idea as I know many get ill after travelling.
 
Doxycycline is a tetracycline and so is, I believe, quite a different drug to the fluroquinolones.

It was interesting to see the mention in the MEA article that doxycycline may have immune function benefits. Certainly the first time I took doxycycline as a malaria prophylactic (pre-ME), I felt remarkably well. However, I think that many extended courses of it changed my gut flora for the worse. Whereas previously I had had an 'iron stomach', able to eat dodgy food without problems, over the years I seemed to have much lower tolerance. I have wondered if changed gut flora caused by doxycycline played a role in causing the ME. However, my two children did not have multiple extended doxycycline courses and they became ill with ME at the same time. So, maybe not.

A couple of years prior to getting ME, I was prescribed a course of ciprofloxacin (one of the fluroquinolones). I remember one incident where I felt really dreadful, quite disoriented and out of it, when I had to drive home from the doctor. I can't say if it was the ciprofloxacin or some fever delirium from the illness, but it was very disconcerting. I also developed tendonitis, before knowing that ciprofloxacin could cause that problem. I think it's a nasty drug and I endorse the MEA's view that this class of drugs should not be used unless all alternatives have been carefully considered.

I have wondered whether the ciprofloxacin was part of the reason that I got ME. There was a residual effect of muscle weakness and I was never quite well after it. If it was just me who developed ME, I might be pointing a finger at it a lot more strongly. But again, my two children didn't have ciprofloxacin and they developed ME at the same time as me. So I'm inclined to think it was not a key factor.
 
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Floroquinolines and such...

I think this is a good warning per se, but I am not sure how the proclamation against antibiotics in general plays in. I am not sure how I feel about them, and I am on a shit-load.

I do know where I am from many of us hold edicts with distrust only surpassed by our contempt for the peeps we don't know who may or may not be behind them, eta,ie, our IMMEDIATE doctors, not those who might advocate differently here.
 
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Tia said:
This is really helpful. Thank you Dr Shepard.

Just wondering - are any of the antimalarials related to this class of antibiotic? I know doxycycline is an antibiotic but don't know if it's related. Probably not - just an idea as I know many get ill after travelling.
Click to expand...

The quinolones are anti-malarials, if that's what you're asking?
 
JaimeS said:
The quinolones are anti-malarials, if that's what you're asking?
Click to expand...
What about quinolines, like Clioquinol? I've found reference to taking this in 2007 around the same time as I started the dreaded perindopril (which put me in hospital with low blood salt).
 
@Hutan

Reading your comment about taking ciprfloxacin allow me to hypothesize that ciprofloxacin may be the cause of your onset of Ilness. Needless to say that certain medications do stress the Liver.

I do not know if the following are a coincidence but it is useful to know in any case :


RESULTS:
After adjusting for confounders, logistic regression analysis indicated a significantly higher overall risk of hepatotoxicity development among fluoroquinolone users relative to controls (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.04-1.38). Drug-specific risk analyses focused on three fluoroquinolone agents (ciprofloxacin, levofloxacin, and moxifloxacin) indicated a significant association between ciprofloxacin use and an increased risk of hepatotoxicity (OR, 1.29; 95% CI, 1.05-1.58); when considered as independent variables, levofloxacin use and moxifloxacin use were not significantly associated with hepatotoxicity risk.

CONCLUSION:
The findings of a national VA safety study suggested an increased hepatotoxicity risk asssociated with fluoroquinolone exposure in the study population.
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Link : https://www.ncbi.nlm.nih.gov/pubmed/24352180


There are mentions of Long term side effects known as Fluoroquinolone-associated Disability (FQAD). I believe that following paper mentions a lot of Topics that we heard before :


Treatment of the Fluoroquinolone-Associated Disability: The Pathobiochemical Implications

Long-term fluoroquinolone-associated disability (FQAD) after fluoroquinolone (FQ) antibiotic therapy appears in recent years as a significant medical and social problem, because patients suffer for many years after prescribed antimicrobial FQ treatment from tiredness, concentration problems, neuropathies, tendinopathies, and other symptoms.
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The paper discusses about Pyruvate Dehydrogenase, Oxidative Stress, Krebs Cycle, Mitochondrial Damage, Fenton Reaction and many, many more :


PTP = Mitochondrial Permeability Transition Pore
OS = Oxidative Stress

On the case of the permanent OS or disturbed state of PTP being inadequately open, this return cannot take place because the ATP production is lowered. The cell being in the resting state comes to the state which can be called “permanent stress adaptation.” In the case of the necessity to increase the metabolic rate, further increase in metabolic rate is difficult because of the lack of physiological adaptation reserve. The final effect for the patient is the feeling of “the lack of energy.” Many other regulative processes take place, of course, as OS adaptation. However, the above-described changes belong in authors’ opinion, to the primary regulatory axes.
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Interestingly, the paper also discusses about increased calcium :

On the other hand, in the case of reduced ATP production, the lowered ΔV opens voltage-gated Ca2+ channels which causes Ca2+ influx into the cell [32]. Increased [Ca2+]i activates calcineurin. Activated calcineurin shifts NFAT (nuclear factor of activated T-cells) to the nucleus where it inhibits Kv1.5 potassium channel production.
Click to expand...


This information is also found on @Simon M 's post in Phoenix Rising :


https://forums.phoenixrising.me/ind...o-multiply-fight-infection.55303/#post-925231


Perhaps someone knowledgeable could look at the paper ?


Link : https://www.hindawi.com/journals/omcl/2017/8023935/
 
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mariovitali said:
@Hutan

Reading your comment about taking ciprfloxacin allow me to hypothesize that ciprofloxacin may be the cause of your onset of Ilness. Needless to say that certain medications do stress the Liver.

I do not know if the following are a coincidence but it is useful to know in any case :




Link : https://www.ncbi.nlm.nih.gov/pubmed/24352180


There are mentions of Long term side effects known as Fluoroquinolone-associated Disability (FQAD). I believe that following paper mentions a lot of Topics that we heard before :




The paper discusses about Pyruvate Dehydrogenase, Oxidative Stress, Krebs Cycle, Mitochondrial Damage, Fenton Reaction and many, many more :


PTP = Mitochondrial Permeability Transition Pore
OS = Oxidative Stress





Interestingly, the paper also discusses about increased calcium :




This information is also found on @Simon M 's post in Phoenix Rising :


https://forums.phoenixrising.me/ind...o-multiply-fight-infection.55303/#post-925231


Perhaps someone knowledgeable could look at the paper ?


Link : https://www.hindawi.com/journals/omcl/2017/8023935/
Click to expand...
Great information. Thanks. Our family member was on Cipro for clostridium Difficile, and then this death-in-life ME set in. Shouldn't drugs like that be prescribed more cautiously, I have to ask.
 
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