Does fluoroquinolone (Fluoroquinolone antibiotic) cause diabetic foot ulcer (ulceration of the foot) in patients with Impaired renal function or diabetes?

From the Guidelines

Fluoroquinolones do not directly cause foot ulcers in patients with impaired renal function or diabetes, but they can cause rare and serious side effects that might indirectly contribute to foot problems in certain patients. These antibiotics, including ciprofloxacin, levofloxacin, and moxifloxacin, are used to treat various bacterial infections but are not known to directly cause ulcerations on the feet 1. However, fluoroquinolones can cause peripheral neuropathy (nerve damage) which may lead to numbness or tingling in the extremities, potentially increasing the risk of unnoticed injuries that could develop into ulcers, especially in diabetic patients. Fluoroquinolones can also cause tendon damage or rupture, particularly in the Achilles tendon, which might alter a person's gait and create pressure points that could lead to ulceration.

Key Considerations

• Patients with diabetes or peripheral vascular disease should be particularly vigilant about foot care while taking fluoroquinolones, as they are at higher risk of developing foot ulcers due to underlying conditions such as peripheral neuropathy and peripheral artery disease (PAD) 1.
• The International Working Group on the Diabetic Foot (IWGDF) recommends regular screening for signs and symptoms of peripheral neuropathy and PAD in patients with diabetes, as well as proper foot care and wound management to prevent foot ulcers 1.
• Clinicians should evaluate diabetic patients presenting with a foot wound at three levels: the patient as a whole, the affected foot or limb, and the infected wound, and diagnose infection based on the presence of at least two classic symptoms or signs of inflammation or purulent secretions 1.

Recommendations

• Patients taking fluoroquinolones should be advised to monitor their feet daily for any signs of injury or infection and to seek medical attention immediately if they notice any unusual symptoms such as pain, numbness, or skin changes.
• Clinicians should consider the potential risks and benefits of fluoroquinolone therapy in patients with diabetes or peripheral vascular disease and take steps to minimize the risk of foot problems, such as prescribing alternative antibiotics or providing additional foot care guidance.
• Patients with diabetes or peripheral vascular disease should be encouraged to follow proper foot care guidelines, including washing their feet daily, drying them carefully, and wearing proper footwear to reduce the risk of foot ulcers 1.

From the Research

Fluoroquinolone Antibiotics and Diabetic Foot Ulcer

• There is no direct evidence to suggest that fluoroquinolone antibiotics cause diabetic foot ulcers in patients with impaired renal function or diabetes 2, 3, 4, 5, 6.
• However, fluoroquinolone antibiotics have been associated with peripheral neuropathy, which can increase the risk of foot ulcers in patients with diabetes 2, 3.
• Peripheral neuropathy is a known complication of diabetes, and fluoroquinolone antibiotics may exacerbate this condition, potentially leading to an increased risk of foot ulcers 3.
• Patients with impaired renal function may be at higher risk of adverse effects from fluoroquinolone antibiotics, including peripheral neuropathy, due to decreased drug clearance 5.
• The use of fluoroquinolone antibiotics in patients with diabetes or impaired renal function should be carefully considered, and alternative treatments should be explored when possible 4, 5.

Risk Factors for Adverse Effects

• Increasing age and concomitant systemic corticosteroid use appear to significantly increase the risk of adverse events associated with fluoroquinolone antibiotics, including peripheral neuropathy and musculoskeletal complications 5, 6.
• Patients with impaired renal function, particularly those with low creatinine clearance values, may require dosage adjustments when taking fluoroquinolone antibiotics to minimize the risk of adverse effects 5.
• Healthcare professionals should be aware of the potential risks associated with fluoroquinolone antibiotics and take steps to minimize these risks, including monitoring patients for signs of adverse effects and adjusting treatment regimens as needed 4, 5.