Adverse effects associated with the use of Cipro and other fluoroquinolone antibiotics are not always mild. They frequently can be severe and permanently disabling, and they may occur following just one or a few doses.

Jay S. Cohen, MD, an associate professor of family and preventive medicine at the University of California, San Diego. He analyzed 45 cases in which fluoroquinolone antibiotics, including 11 cases involving Cipro, were associated with adverse effects involving the peripheral nervous system such as tingling, numbness, burning pain, twitching, or spasms.

Of those 45 cases, 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.

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 Cipro by thousands of people, it is imperative that physicians and the public understand the benefits and potential risks of using Cipro or other fluoroquinolone antibiotics indiscriminately. The media have, generally, presented only a few fluoroquinolone adverse effects, which are usually described as mild and brief.

Annals of Pharmacotherapy December, 2001