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.

“Patients in the hospital are vulnerable and are at higher risk of developing more severe illness from the flu, or even a simple cold. If you have a contagious illness, it’s important you don’t visit people in the hospital until you’ve fully recovered,” says Dr. Jerome Leis, Medical Director of Infection Prevention and Control at Sunnybrook.

Here are three reasons you shouldn’t visit patients in the hospital when you’re sick:

1. You can pass your illness on to others

There are posters around the hospital and a recording on the main phone line, asking visitors not to come to Sunnybrook if they’re sick.

Before you visit someone in the hospital, be honest with yourself about your own health: it’s easy to dismiss a minor cough or runny nose as an allergy, aspiration or unrelated non-infectious issue.

However, these can be signs of a contagious infection, which can spread quickly to other patients and staff. The resulting outbreak can have a huge impact not just on other patients, but also on the hospital’s ability to function efficiently.

2. It creates a domino effect

When patients get an infectious illness while in the hospital, it creates a domino effect.

Their hospital stay becomes longer and they need more care, leading to delays in care for other patients. For example, surgeries can be delayed or even cancelled, and patients can wait longer in the Emergency Department for a bed.

“This is one of the reasons we often see a spike in our occupancy rates in the winter months. Patients are getting illnesses like the flu, even when that isn’t the reason they were originally admitted to our hospital, causing them to stay longer,” says Dr. Leis.

3. Patients need more time and help to recover

When a patient catches the flu while in the hospital, it can cause additional complications and delays in their recovery.

“Sometimes, it can mean the difference between a patient being able to go home or needing rehabilitation and additional support, because the flu they caught in hospital caused them to become even weaker,” says Dr. Leis.

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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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