Chronic Quinolone Toxicity

What are quinolone antibiotics?

Cipro (ciprofloxacin), Levaquin (levofloxacin), Avelox (moxifloxacin)

What are they used for?

Quinolone antibiotics are commonly prescribed for bladder infection, prostate infection, pneumonia, sinusitis and upper respiratory infections.

What causes chronic quinolone toxicity?

To maintain strength and heal wounds, soft tissues produce collagen, a rope-like protein that provides strength and flexibility in tissues like ligaments and tendons and muscles. Collagen production is also important in healing injuries and in healing wounds, including post-operative wounds. Collagen provides strength in the walls of arteries and in joints all over the body.

How do tissues make collagen? Genes have the instructions. Genes are uncoiled, the instructions are read by messenger RNA, then the genes are coiled back into their normal position. The uncoiling and recoiling process is governed by iron-dependent enzyme systems. Without iron, these enzyme systems can get stuck. When the genetic uncoiling reading and recoiling process becomes dysfunctional, tissues can no longer produce collagen normally. It’s not a genetic problem, but an “epigenetic” problem, meaning that it’s not bad genetic information, but rather that the body is unable to read and interpret and use the information contained in the genes.

tissues don’t heal well.

When tissues can no longer produce collagen, they can’t heal themselves. Joint pain often starts within a few weeks after taking quinolone antibiotics. Inflammation and pain commonly begin in the tendons and ligaments of the feet and ankles, progressing upward to knees, hips, back and hands. Joint pain can be associated with swelling called joint effusions. Arterial aneurisms can develop and enlarge. Hernias can develop in odd places. Orthopedic surgeries and other types of surgeries may not heal well. In our experience, it’s not uncommon for patients to need multiple orthopedic surgeries for the same problem. Abnormal menstrual periods, infertility and chronic dyspareunia can occur. Chronic quinolone toxicity can be manifested in the central and peripheral nervous systems. Insomnia, headache and peripheral neuropathy can occur. All ages can be affected.

How do quinolone antibiotics cause chronic quinolone toxicity?

There are probably several ways quinolones cause adverse effects. One is by altering iron metabolism. Normally, the body keeps plenty of iron available in storage, to be used when needed. Not always, but sometimes quinolone antibiotics like Cipro and Levaquin bind to iron so that the iron is no longer available to be used by the gene-reading enzyme systems. Once those enzymes get stuck, they can remain dysfunctional for years. We’ve seen patients who’d suffered from symptoms of chronic quinolone toxicity for one or two decades.

Can chronic quinolone toxicity be reversed?

The underlying metabolic problems can be reversed, at least temporarily. It’s not easy. Strict adherence to a treatment program is necessary. How long does it take to start to see improvement? That can depend on the number and frequency of quinolone exposures, and on how the disease is being manifested. Neurological complications can take longer to heal than tendon and muscle problems.

any helpful ideas for managing this problem?

Collagen production can be improved by taking vitamin C and magnesium supplements.

Co-Q 10 supplements can also help.

During starvation, the body breaks down collagen to use the proteins as a source of energy by producing glucose. Don’t fast.

The body also breaks down collagen when muscles are not used, like when you stay in bed for excessively long periods, or when you don’t walk around or get any exercise. When you’re having lots of pain, exercise of any type may seem impossible. But weight bearing (by walking around even if you need some help) can help prevent loss of collagen.

Taking steroids decreases the rate of collagen production in all tissues, including bone, muscle and tendons. If possible, avoid taking steroids. If you must, then take them for as short a time as possible.

Aneurysms can develop from arteries that enlarge, which can cause symptoms of abdominal pain associated with localized tenderness of a pulsatile artery. Patients with CQT who develop leg swelling may need to be tested for May-Thurner syndrome. Intracranial aneurysms can cause neurological symptoms. Enlarging aneurysms of any type require urgent aggressive medical treatment.

Loss of collagen in the skin can produce loose sagging skin and hair loss. We believe urgent medical treatment is indicated for loose skin.

Loose joints and loose skin from Ehlers-Danlos syndrome can be worsened by CQT.

Loss of collagen in the veins and small fiber neuropathy can cause dysautonomia and POTS.

Because postoperative complications can develop from delayed wound healing, elective surgery may involve higher risks, which need to be taken into account in evaluating the risk/benefit ratio of any planned surgical procedure.

CQT is a complicated disease which is under-appreciated and needs to be studied intensely by the health care community. There is much work to be done.

How do I know if I have chronic quinolone toxicity?

Chronic quinolone toxicity is a clinical diagnosis, and can be associated with a number of different types of symptoms. (See above.)