From the Guidelines
Patients taking fluoroquinolones should be monitored for potential adverse effects, including tendonitis, tendon rupture, and QT interval prolongation, which can increase the risk of torsades de pointes.
Key Monitoring Parameters
- Liver function tests: Monitoring of liver function is recommended, especially in patients with pre-existing liver disease, as fluoroquinolones can cause liver injury 1.
- QT interval: Patients taking fluoroquinolones should be monitored for QT interval prolongation, especially those with a history of cardiac arrhythmias or taking other medications that can prolong the QT interval 1.
- Tendonitis and tendon rupture: Patients should be advised to report any symptoms of tendonitis or tendon rupture, such as pain or swelling in the tendons, as fluoroquinolones can increase the risk of these conditions 1.
- Clostridium difficile infection: Patients taking fluoroquinolones should be monitored for symptoms of Clostridium difficile infection, such as diarrhea or abdominal pain, as fluoroquinolones can increase the risk of this infection 1.
Special Considerations
- Renal function: Patients with renal impairment should be monitored closely, as fluoroquinolones can accumulate in the body and increase the risk of adverse effects 1.
- Drug interactions: Patients taking fluoroquinolones should be monitored for potential drug interactions, such as with medications that can prolong the QT interval or increase the risk of tendonitis 1.
From the Research
Monitoring for Patients Taking Fluoroquinolones
To ensure safe use of fluoroquinolones, it is crucial to monitor patients for potential adverse effects. The following points highlight key considerations:
- Tendinopathy and Tendon Rupture: Patients should be monitored for signs of tendinopathy and tendon rupture, particularly those with risk factors such as chronic renal disease, concomitant use of corticosteroids, and age over 60 years 2, 3, 4.
- Peripheral Neuropathy: Fluoroquinolones have been associated with an increased risk of peripheral neuropathy, and patients should be monitored for symptoms such as numbness, tingling, or pain in the hands and feet 2.
- Aortic Aneurysm: There is an increased risk of aortic aneurysm associated with fluoroquinolone use, and patients should be monitored for symptoms such as abdominal pain or back pain 2.
- Central Nervous System (CNS) Reactions: Elderly patients, particularly those with impairments of the CNS (e.g., epilepsy, pronounced arteriosclerosis), should be treated with fluoroquinolones under close supervision due to the risk of CNS reactions such as confusion, weakness, loss of appetite, tremor, or depression 3.
- QT Interval Prolongation: Fluoroquinolones can cause QT interval prolongation, and patients with known prolongation of the QT interval, uncorrected hypokalaemia or hypomagnesaemia, or those receiving class IA or III antiarrhythmic agents should be avoided or monitored closely 3.
- Gastrointestinal Reactions: Patients should be monitored for gastrointestinal reactions such as diarrhea, nausea, and vomiting, although these are less common compared to other antibacterials 3, 5.
- Renal Function: Patients with declining renal function should have their fluoroquinolone dosage adjusted accordingly, as renal function declines consistently with age 3, 5.
- Patient Factors: Clinicians should evaluate patients for factors that increase the risk of fluoroquinolone-associated reactions, ensuring that fluoroquinolone therapy is safe and effective 6.