Recently, you may have heard about fluoroquinolones in the news. A class of antibiotics approved to treat certain bacterial infections, they’ve been in use for more than 30 years. Fluoroquinolones work by killing or stopping the growth of bacteria that can cause illness and infections. Without treatment, some of these infections can spread and lead to serious health problems.

In December 2018, the U.S. Food and Drug Administration (FDA) issued a warning to health care providers about the use of fluoroquinolones in certain higher risk groups, including those with hypertension, certain genetic conditions and the elderly.

So, what does this mean for you as a patient?

Dr. Nick Daneman, a clinician-scientist in infectious diseases at Sunnybrook, led a research study on fluoroquinolones that was published in 2015. It was one of the first to establish a link between the use of fluoroquinolones and an increased risk of aortic aneurysms, which can lead to dangerous bleeding or even death.

“There was strong anecdotal evidence that fluoroquinolones weakened the collagen in major tendons like the Achilles’, and we wanted to confirm that it did, in fact, lead to a higher risk of tendon injuries,” says Dr. Daneman.

“And then we thought, ‘is it possible that this medication impacts collagen in other areas, like the wall of the aorta (the largest artery in our body)?”

The results of the study were a resounding ‘yes’.

The researchers began by looking at the data of over 1.7 million Ontarians who turned 65 between April 1, 1997 and March 31, 2012; thirty-eight per cent of those people received at least one fluoroquinolone (including ciprofloxacin, norfloxacin, levofloxacin, moxifloxacin and ofloxacin) during that time period.

Of that patient group, the researchers found that 2.1% of them experienced tendon ruptures and 1.1% experienced aortic aneurysms. The risk of tendon rupture was tripled, and the risk of aortic aneurysm was doubled, during the time periods when patients were taking fluoroquinolones.

The connection between fluoroquinolones and aortic aneurysms was so strong that Dr. Daneman and his team were actually met with disbelief when submitting their research paper for publication.

“One editor kept asking us to send more and more supporting documentation, because he couldn’t believe that an association this strong hadn’t been noticed for so long,” says Dr. Daneman.

“But no matter how you looked at it, the evidence was clear: patients who were taking or had recently taken fluoroquinolones were at a higher risk of tendon or aorta rupture.”

Dr. Daneman and his team’s findings were so strong, their research was cited in the 2018 warning issued by the FDA.

However, this doesn’t mean that fluoroquinolones should never be used – even though they issued a warning, the FDA still recommends prescribing fluoroquinolones to those higher risk patients when no other treatment options are available.

Dr. Daneman agrees that there is still a place for fluoroquinolones, and that they remain a valuable treatment option for many patients.

“If a patient is ill with an infection, fluoroquinolones remain one of the important weapons in your treatment arsenal,” he says.

“As with any area of medicine, clinicians just have to make sure they weigh the risks against the benefits to make the best choice for their patients.”

The post Behind the research: is it safe to take fluoroquinolone antibiotics? appeared first on Your Health Matters.

Not so fast.

“If your cold has been caused by a virus, antibiotics aren’t going to do anything for you. Antibiotics only treat infections caused by bacteria, not viruses like colds and the flu,” says Dr. Jerome Leis, medical director, infection prevention and control at Sunnybrook.

“The best way to treat most colds, coughs or sore throats is with plenty of fluids and rest.”

So, while you’ll likely be prescribed antibiotics for a bacterial infection like pneumonia, you won’t get antibiotics if you’re suffering from the common cold, which is a viral illness.

It’s not just because the antibiotics won’t work for you. There’s another, larger-scale reason: antibiotic resistance.

Antibiotic resistance happens when bacteria change and become resistant to the antibiotics used to treat the infections they cause. It’s making it more difficult to treat infectious diseases, and is undermining many advances in medicine.

Without effective antibiotics, infections can result in longer illnesses and more deaths. In fact, antibiotic resistance is one of the biggest threats to global health today.

“Current worldwide estimates of deaths attributed to untreatable infections directly from antibiotic resistance are at about 700,000 a year,” says Dr. Leis.

“At our current rate of antibiotic overuse, and without the development of new drugs, by 2050 that number is expected to rise to 10 million deaths worldwide. This is more than what we see from cancer today.”

As a patient, there are four things you can do to help make sure antibiotics remain effective for those who need them:

1. Only use antibiotics as prescribed

You should only use antibiotics when prescribed to you by a certified health professional

2. Never use leftover antibiotics

Different antibiotics are used to treat different types of infections. Even if you believe your infection has recurred, seek medical attention to determine the cause and whether antibiotics are still right for you

3. Don’t share antibiotics with others

They can put your friends and family at risk. Antibiotics can cause side-effects like allergic reactions, development of C.difficile diarrhea and serious drug interactions. Plus, sharing antibiotics promotes the development of antibiotic-resistant organisms

4. Prevent infections

Regularly wash your hands, avoid close contact with sick people and keep your vaccinations up to date

The post Why no amount of antibiotics will help get rid of your cold appeared first on Your Health Matters.

Penicillin allergies seem to be surprisingly common – or are they?

One in ten Canadians report having a penicillin allergy, but very often, an allergic reaction is unrelated to having received penicillin. The reaction could have been caused by a number of other factors, like food or another medication.

In fact, a recent study led by Sunnybrook found that patients who had previously reported a penicillin allergy are often able to receive the drug after a simple bedside skin test known as BLAST, which stands for beta-lactam allergy skin testing.

“The majority of inpatients who report an allergy to penicillin could likely tolerate it if they received it. Doing a bedside allergy skin test helped us determine who those patients were,” says Dr. Jerome Leis, lead study author and Medical Director of Infection Prevention and Control at Sunnybrook.

What’s the big deal if you mistakenly think you have a penicillin allergy?

If you end up in the hospital with a life-threatening infection, the best (or only) treatment option may be penicillin.

Declaring an allergy to penicillin means not being able to access more than 20 drugs from the arsenal of potential treatments. You may receive less effective antibiotics to treat your infection, and experience poorer outcomes as a result.

“In addition to some of the more toxic side effects associated with alternate therapy to penicillin, some of these alternative drugs don’t reach the site of infection. Limiting the use of those alternate therapies also reduces antibiotic resistance,” says Lesley Palmay, study co-author and Infectious Diseases Consult Service Pharmacist at Sunnybrook.

In the Sunnybrook study, 99% of participants who previously reported a penicillin allergy were treated with penicillin without complication. These results show that bringing skin testing to the bedside improves treatment of serious infections.

Bedside skin testing is now standard practice at Sunnybrook. “Now, the right patient can receive the right antibiotic for their infection, without fear of an allergic reaction,” says Dr. Leis.

How to be sure whether or not you have a penicillin allergy

Many people outgrow their penicillin allergy, or may be able to receive the drug in controlled doses. Are you one of them?

Ask your family doctor to review your history and decide whether you are a candidate for allergy testing. Testing involves surface skin testing, followed by oral administration of a penicillin antibiotic over the course of six hours in the Drug Safety Clinic at Sunnybrook.

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Over the past century, access to effective antibiotics has saved millions of lives, and enabled major medical and surgical breakthroughs. The misuse and overuse of antibiotics, however, has contributed to a phenomenon known as antibiotic resistance.

“Antibiotic resistance is rising to dangerously high levels in all parts of the world, including Canada. It threatens our ability to treat common infectious diseases, resulting in prolonged illness, disability and death,” says Christine Peragine, Pharmacist and Clinical Research Fellow in Antimicrobial Stewardship and Infectious Diseases at Sunnybrook.

Antibiotic resistance is increasing the overall cost of health care, by contributing to lengthier hospital stays for patients and more intensive care unit admissions.

It’s also impacting many of the medical advancements we take for granted, like organ transplants, chemotherapy for cancer treatment, diabetes management and major surgeries. To be successful, these conditions and procedures require effective antibiotics, because they have a high risk of infection. If current trends continue, it will become more difficult to achieve good outcomes for patients.

Here’s what you need to know about antibiotic resistance:

What is antibiotic resistance?

Resistance develops when potentially harmful bacteria change in a way that makes them immune to antibiotics. Resistant bacteria survive, multiply and spread, causing more harm.

How does antibiotic resistance happen?

Drug resistance is a natural evolutionary phenomenon. When people take antibiotics for a bacterial infection, the antibiotic kills off the “weaker” organisms. However, there may be some organisms that are resistant to the antibiotic, so they aren’t killed off. This allows them to multiply and spread, meaning that the next generation of the bacterial infection will no longer respond to (or be killed off by) that antibiotic.

Why is antibiotic resistance a problem?

Antibiotic resistance is a problem because standard treatments become ineffective. An antibiotic that used to work on certain infections no longer does. People are unable to recover from infections, and may then spread those infections to others.

In Canada, the prevalence of resistant- and multi-drug resistant bacteria (also known as ‘superbugs’) is increasing. We are one step away from creating a superbug resistant to all commercially available antibiotics that would be capable of defeating every antibiotic in the medicine cabinet.

What can you do to reduce antibiotic resistance?

If you’ve been prescribed antibiotics, there are a few easy steps you can take to prevent antibiotic resistance:

1. Only take antibiotics in the way they have been prescribed to you

2. Don’t ask for antibiotics to treat viral infections like colds and the flu. Antibiotics have no effect on viruses, and won’t speed up your recovery from viral infections

3. Clean your hands often! It is possible to pass on antibiotic resistant bacteria to others, so prevent the spread of germs by practicing good hygiene

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