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NL-1-2014-LETTER-1 CELLS... CELLS IN LIVING MICE 'REPROGRAMMED' TO EMBRYONIC-LIKE STATE S. Sharmilabanu.,(B.Pharm Final Year), Vels university. Stem cells Stem cells are undifferentiated biological...


NL-1-2014-LETTER-2 -... BETTER ACTION ON WARFARIN ON YOUNGER HEART FAILURE PATIENTS   By:  Dhulipala Sowmya.,(B-Pharm II year),Vels University Warfarin may be more beneficial than aspirin in...


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NL-1-2014-LETTER-4... PROGERIA By:  Prithivi Logathasan,(B-Pharm III Year),Vels University HGPS (Hutchinson-Gilford Progeria Syndrome) or Progeria is an extremely rare, fatal genetic condition....


NL-1-2014-LETTER-5... OBESE MADE LEAN BY LEANS By:  S.Santhya.,(B-Pharm-Final Year)Vels University The Microbes from Lean People Act as Anti-Obesity Agents. Bugs that lurk in the guts of slim...


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Sarumathy S*, Senthilnathan B, Ravichandiran V

School of Pharmaceutical Sceinces, Vels University (VISTAS), Pallavaram, Chennai-600117.

Fluoroquinolones are one of the most commonly prescribed classes of antibiotics. Ciprofloxacin, levofloxacin, moxifloxacin and gemifloxacin are widely used for the treatment of various types of bacterial infections. Their broad-spectrum antibacterial coverage and high-tissue distribution provide advantage for prescribing in variety of community-acquired infections. Though it is well tolerated and has good safety index, they are found to be associated with a wide range of adverse events such as dysglycemia1, cardiac arrhythmia2, and neuropsychiatric events3. Fluoroquinolones also have been linked to several forms of ocular toxicity such as corneal perforations4, optic neuropathy5, and retinal hemorrhages6. They have also been issued to cause tendon rupture7, which raises concerns for the effect of these drugs on connective tissue in the eye. The putative mechanism behind a possible fluoroquinolone-induced retinal detachment may be through the destructive effect of the drugs on collagen and connective tissue8. Collagen fibers play a pivotal role in the structure and integrity of the vitreous body9. Thus, breakdown of collagen, possibly secondary to fluoroquinolone therapy, may promote the development of posterior vitreous detachment, leading to an increased risk of retinal detachment. Retinal detachment is a serious medical emergency that may lead to irreversible vision loss. Up to 40% of those who experience this event may experience significant loss of visual acuity despite surgical intervention10. In a nested case-control study of a cohort of patients in British Columbia, Canada, who had visited an ophthalmologist between January 2000 and December 2007. Overall, the annual incidence of retinal detachment in the United States is estimated to be 12 per 100,000 patients. Given an exposure prevalence of about 10 percent and assuming a similar risk increase in the general population, the study authors estimate the population-attributable risk to be about 4 percent. Thus, they estimate that 1,440 cases of retinal detachment diagnosed each year in the United States may be attributed to oral fluoroquinolone use11. In another cohort study based on the general Danish population, oral fluoroquinolone use was not associated with increased risk of retinal detachment. Given its limited power, this study can only rule out more than a 3-fold increase in the relative risk associated with current fluoroquinolone use; however, any differences in absolute risk are likely to be of minor, if any, clinical significance12. Given that oral fluoroquinolones are one of the most prescribed classes of antibiotics, it is important that their full risk and safety profile be known.


1. Park-Wyllie LY, Juurlink DN, Kopp A, et al.  Outpatient gatifloxacin therapy and dysglycemia in older adults.  N Engl J Med. 2006;354(13):1352-1361

2. Falagas ME, Rafailidis PI, Rosmarakis ES. Arrhythmias associated with fluoroquinolone therapy.  Int J Antimicrob Agents. 2007;29(4):374-379

3. Leone R, Venegoni M, Motola D, et al.  Adverse drug reactions related to the use of fluoroquinolone antimicrobials: an analysis of spontaneous reports and fluoroquinolone consumption data from three italian regions.  Drug Saf. 2003;26(2):109-120

4. Al-Amri AM. Corneal perforation associated with topically applied gatifloxacin.  Cornea. 2008;27(3):370-371.

5. Samarakoon N, Harrisberg B, Ell J. Ciprofloxacin-induced toxic optic neuropathy.  Clin Experiment Ophthalmol. 2007;35(1):102-104

6. US Department of Health and Human Services; US Food and Drug Administration.  Labeling revision: supplement approval letter (NDA 21158/S-018). Accessed January 27, 2011

7. Szarfman A, Chen M, Blum MD. More on fluoroquinolone antibiotics and tendon rupture.  N Engl J Med. 1995;332(3):193

8. Khaliq Y, Zhanel GG. Fluoroquinolone-associated tendinopathy: a critical review of the literature.  Clin Infect Dis. 2003;36(11):1404-1410

9. Ponsioen TL, van Luyn MJ, van der Worp RJ, van Meurs JC, Hooymans JM, Los LI. Collagen distribution in the human vitreoretinal interface.  Invest Ophthalmol Vis Sci. 2008;49(9):4089-4095

10. Sodhi A, Leung LS, Do DV, Gower EW, Schein OD, Handa JT. Recent trends in the management of rhegmatogenous retinal detachment.  Surv Ophthalmol. 2008;53(1):50-67.

11. Etminan M,  Forooghian F, Brophy MJ, Bird ST, Maberley D. Oral Fluoroquinolones and the Risk of Retinal Detachment. JAMA. 2012;307(13):1414-1419.


12. 12 Pasternak B, Svanström H, Melbye M, Hviid A. Association between oral fluoroquinolone use and retinal detachment. JAMA. 2013;27;310(20):2184-90.


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