Fluoroquinolone Use Linked to Higher Risk of Peripheral Neuropathy

Fluoroquinolones are widely used antibiotics for various infectious etiologies. Generally, these antibiotics are well tolerated but they carry the risk of peripheral neuropathy as a rare but serious adverse effect.  The risk and its severity between individual agents is uncertain. The onset of peripheral neuropathy can occur rapidly, often within a few days of starting a Fluoroquinolone, and in some patients the disorder may be permanent (1).

Etminan et al. conducted a  case-control study to quantify the risk of peripheral neuropathy associated with oral Fluoroquinolone use. They found that Current users of Fluoroquinolones were at a higher risk of developing peripheral neuropathy (Risk Ratio (RR) = 1.83, 95% confidence interval [CI] 1.49-2.27). Among them, current new users were at the highest risk (RR = 2.07, 95% CI 1.56-2.74) (2).

Recently, another case-control study was published evaluating the association of Fluoroquinolone exposure with peripheral neuropathy. This nested case-control study showed that the absolute risk of the peripheral neuropathy with oral Fluoroquinolone exposure was 2.4 (95% CI, 1.8 to3.1) per 10,000 patients per year. The relative incidence of peripheral neuropathy was elevated significantly upon exposure to Fluoroquinolone, with an adjusted incidence rate ratios (IRR) of 1.47 (95%CI, 1.13 to 1.92). The risk was higher in men and among those older than 60. Risk increased by approximately 3% for each additional day of Fluoroquinolone exposure and persisted for up to 180 days following exposure (3).

Existing literature indicates that healthcare providers should consider the potential riskof peripheral neuropathy with patients when prescribing Fluoroquinolones.

Key points:

• Peripheral neuropathy associated with Fluoroquinolone exposure is time and dose dependent.

• Current users, especially new users of Fluoroquinolones, are at a higher risk of developing Peripheral neuropathy

• Men and individuals older than 60 are at a higher risk of peripheral neuropathy as a result of exposure to f Fluoroquinolones.

References:

Francis JK, Higgins E. Permanent Peripheral Neuropathy: A Case Report on a Rare but Serious Debilitating Side-Effect of Fluoroquinolone Administration. J Investig Med High Impact Case Rep. 2014 Jul 27;2(3)

Etminan M, Brophy JM, Samii A. Oral fluoroquinolone use and risk of peripheral neuropathy: a pharmacoepidemiologic study. Neurology. 2014 Sep 30;83(14):1261-3. 

Morales D, Pacurariu A, Slattery J, Pinheiro L, McGettigan P, Kurz X. Association Between Peripheral Neuropathy and Exposure to Oral Fluoroquinolone or Amoxicillin-Clavulanate Therapy. JAMA Neurol. 2019 Jul 1;76(7):827-833.