Fluoroquinolones and Peripheral Neuropathy – Another Look

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An article published in the journal Neurology entitled “Oral fluoroquinolone use and risk of peripheral neuropathy: A pharmacoepidemiologic study” found that users of fluoroquinolones are at a higher risk of developing peripheral neuropathy than those in a control group – with those currently using fluoroquinolones at the highest risk.  I am thankful to Doctors Etminan, Brophy and Samii for their work!  The study quantifies the risk of developing peripheral neuropathy after using fluoroquinolones.  The results are:

“We identified 6,226 cases and 24,904 controls. Current users of FQs were at a higher risk of developing PN (RR = 1.83, 95% confidence interval [CI] 1.49-2.27). Current new users had the highest risk (RR = 2.07, 95% CI 1.56-2.74). No risk was observed for current users of finasteride (RR = 1.21, 95% CI 0.97-1.51).”

A review in Neurology Today, about the study, featured some expert comments.   Some of those comments, frankly, pissed me off.  From the review in Neurology Today –

“Ahmet Hoke, MD, PhD, a professor of neurology and neuroscience and director of the Daniel B. Drachman Division of Neuromuscular Diseases at Johns Hopkins School of Medicine in Baltimore, MD, expressed reservations about the Neurology study, however, because there are so many kinds of peripheral neuropathy, many of them apparently caused by infection. “It is very difficult to know if [fluoroquinolones] are causing the neuropathy, because most of the patients follow a course that is similar to post-infectious peripheral neuropathy,” said Dr. Hoke, who is also the editor-in-chief of Experimental Neurology. “Since these antibiotics are always given to patients who have active infections, we don’t know if the infection or the drug is triggering the neuropathy. It’s more likely that the infection, which may have been there for four or five days before the antibiotic was started, caused this neuropathy.”

Bacterial infections don’t cause peripheral neuropathy.  They just don’t.  The bacteria that lead to urinary tract infections cannot cause peripheral neuropathy.  The bacteria that lead to sinus infections can’t cause peripheral neuropathy either.  In the billions of years of life on this planet in which eukaryotic organisms have been suffering from bacterial infections, there is no history of bacterial infections causing peripheral neuropathy.  It’s simply false.  I would say that Dr. Hoke is lying, but I don’t know his intentions.  What I do know is that his statement and his assumptions are wrong.

There is currently a connection between bacterial infections and peripheral neuropathy because antibiotics cause peripheral neuropathy.  It is foolish to mistake the effects of a drug given to treat a disease for the symptoms of the disease itself.  (Read Anatomy of an Epidemic for a description of how this is done rampantly in the field of Psychiatry.)

Here is the probable mechanism for fluoroquinolone induced peripheral neuropathy:

Synthetic bactericidal antibiotics, including fluoroquinolones, beta-lactams and aminoglycosides, damage mitochondria and lead to an increase in reactive oxygen species (ROS) (source).  Damaged mitochondria lead to an insufficient supply of ATP and “Mitochondrial conditions that are due to an insufficiency of ATP, especially in organs that rely on mitochondria for their energy source, include developmental disorders of the brain, optic neuropathy, neuropathic pain, hearing loss, muscle weakness, cardiomyopathy, and lactic acidosis.” (The source for that quote is an FDA document entitled “Disabling Peripheral Neuropathy Associated with Systemic Fluoroquinolone Exposure.”)  Of course, the complexity of the biochemical reactions needs more than a couple sentences to explain sufficiently, but the gist of it is that drugs that damage mitochondria can cause peripheral neuropathy.  Other people at Johns Hopkins realize this – this article, “Feet First? Old Mitochondria Might Be Responsible For Neuropathy In The Extremities” is out of Johns Hopkins Medicine.  Maybe they should pass the memo onto Dr. Hoke.

Dr. Hoke and others – what is the mechanism by which you think bacteria cause peripheral neuropathy?  There is none, because they don’t.

Another doctor who reviewed the study, Dr. Wolfe, “noted that infections themselves, such as hepatitis B and C, HIV, and diphtheria, can generate neuropathy.”

Other than diphtheria, THOSE ARE VIRUSES.  (If you’re using fluoroquinolones, or any other antibiotics, to treat viral infections you should probably go back to Med School.)

I seriously doubt that viruses can cause peripheral neuropathy either.  In the case of HIV, peripheral neuropathy is probably from the mitochondria damaging drugs that are given to patients with HIV.  In Mitochondria as a Target of Environmental Toxicants, it is noted that:

“Another example is the nucleoside reverse transcriptase inhibitors (NRTIs) that are used to combat human immunodeficiency virus (HIV) infection. NRTIs act by inhibiting the reverse transcriptase activity required for viral replication. They have been highly successful in treating adults and in preventing transmission of HIV from pregnant mothers to their children, but unfortunately many NRTIs also inhibit the mtDNA polymerase γ. This has resulted mtDNA depletion- and mutation-mediated mitochondrial toxicity, and even death, in patients and in animal models (Benhammou et al., 2007; Blanche et al., 1999; Chan, 2007; Claessens et al., 2003; Divi et al., 2010; Kohler and Lewis, 2007). Similar effects have been observed with nucleoside analogs intended for other viruses as well (McKenzie et al., 1995). Thus, chemicals that damage mtDNA or alter its copy number can have very serious health consequences.”

In “Delayed cytotoxicity and cleavage of mitochondrial DNA in ciprofloxacin-treated mammalian cells” it is noted that fluoroquinolones cause a loss of mitochondrial DNA.

Both NRTIs, used to treat HIV, and fluoroquinolones, used to treat bacterial infections, deplete mitochondrial DNA and lead to peripheral neuropathy.  I don’t understand why this is so difficult, or why people have to obfuscate the issue by making false statements about bacteria and viruses causing peripheral neuropathy.  Neither bacteria nor viruses cause peripheral neuropathy.  The drugs to treat them do.

I shouldn’t know more about drug induced mitochondrial dysfunction and peripheral neuropathy than these doctors.  It’s absurd that I do.

Sources:

  1. Neurology, “Oral fluoroquinolone use and risk of peripheral neuropathy: A pharmacoepidemiologic study.”
  2. Neurology Today, “New Support for Association Between Fluoroquinolones and Peripheral Neuropathy
  3. Science Translational Medicine, “Bactericidal Antibiotics Induce Mitochondrial Dysfunction and Oxidative Damage in Mammalian Cells
  4. Department of Health and Human Services Public Health Service Food and Drug Administration Center for Drug Evaluation and Research Office of Surveillance and Epidemiology, Pharmacovigilance Review, April 17, 2013, “Disabling Peripheral Neuropathy Associated with Systemic Fluoroquinolone Exposure
  5. Johns Hopkins Medicine News and Publications, “Feet First? Old Mitochondria Might Be Responsible For Neuropathy In The Extremities
  6. Toxicological Sciences, “Mitochondria as a Target of Environmental Toxicants
  7. Molecular Pharmacology, “Delayed cytotoxicity and cleavage of mitochondrial DNA in ciprofloxacin-treated mammalian cells.”

 

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9 thoughts on “Fluoroquinolones and Peripheral Neuropathy – Another Look

  1. Lisa Bloomquist October 23, 2014 at 11:26 am Reply

    I realized after I published this that Dr. Hoke is the main person behind http://m.hopkinsmedicine.org/news/media/releases/feet_first_old_mitochondria_might_be_responsible_for_neuropathy_in_the_extremities. So, he obviously realizes the role that mitochondria play in peripheral neuropathy. Does he not realize that fluorouqinolones deplete mitochondrial DNA and damage mitochondria? They do. Here are two articles on the topic – http://www.bu.edu/abl/files/stm_kalghatgi.pdf and http://m.molpharm.aspetjournals.org/content/50/5/1178.abstract. There are more. Mitochondria are ancient descendants of bacteria. Does he think that drugs that disrupt the DNA replication process for bacteria leave human mitochondria unscathed? They don’t. Fluoroquinolones have been shown to damage human mitochondria. If anyone should be able to make the connection between that damage and peripheral neuropathy, it should be Dr. Hoke.

    I have now lost all faith in the people who should know this stuff. Thanks for that, Dr. Hoke.

  2. Debs October 24, 2014 at 4:07 am Reply

    You & me both Lisa, & I had no faith to start with , myself being a survivor also of the ‘ field of psychiatry’ , thanks to them mistaking the ‘side effects ‘ of the psychotropic drugs they prescribed for me in order to treat my so called ‘ bipolar disorder ‘,( actually a neuropsychiatric ADR of FQ triggered acute toxic psychosis ), which they gave me which in turn then triggered severe artificial mood swings, & sent me headlong into a psychotic tailspin to Iatrogenic ‘ bipolar land ‘ hell on earth, which I only recovered from, once I got myself OFF the damned drugs, it actually took me 12 years to climb out of that hellhole, I was lucky to escape with my life, as it is I have been left permanently cognitively damaged. This then caused me to question the psychotropic drugs, in fact the whole of psychiatry this triggered 14 years ( & ongoing) of research in to every aspect of psychiatry.

    I would like to just say a quick thank you here Lisa, for your mention of the truly shocking eyeopening book ‘ Anatomy of an epidemic ‘ by Robert Whitaker.
    This truly is a groundbreaking book, based as it is on the medical evidence & historical documentation, which actually shows up the ‘ science of psychiatry ‘ for the very unstable house of cards it in fact is . The belief psychiatry fosters that chemical imbalances in the brain are the cause for the so called ‘ diseases ‘ of mental illness , which they then insist have to be treated with extremely toxic psychotropic ( and please keep in mind that these too are mitochondrial damaging ) drugs, is in fact completely false, & something which is ALSO devastating untold numbers of lives.

    Anyone who is taking a psychotropic drug, or is thinking of taking them, please keep in mind that because of Big Pharmas’ history with, & ongoing influence on every aspect of psychiatry, you will NEVER get full informed consent on psychotropic drugs from a psychiatrist. Please, get your own informed consent on the psychotropic drugs, research them BEFORE you decide whether or not to risk taking them, & IMO most importantly of all, PLEASE take the time to read this book, believe me, if you do so, you will NEVER see psychiatry in the same way again.

    • Lisa Bloomquist October 24, 2014 at 7:17 am Reply

      I watched Robert Whitaker’s presentation that you linked to on the home page about a month ago. It was excellent – and horrifying at the same time.

      Thank you for all that you do, Debs! 🙂

  3. glowindigochild October 26, 2014 at 8:24 pm Reply

    Reblogged this on glowindigochild's Blog and commented:
    Sharing my much more experienced, educated, brilliant Researcher, Writer, Amazingly knowledgeable, supportive Friend and Blogger’s very well researched, very well written Article concerning a recent Article that concerns the damage done by Fluoroquinolones’ adverse effects on the Mitochondria. Please see the Blog: Floxie Hope, for more of her Blogs and Articles.

  4. Staveren October 27, 2014 at 3:00 pm Reply

    Lisa, it makes me so sad that we have to be educating doctors continuously. Your writing and thoughts are so valuable to me, please keep on writing as much as possible. I am doing my best at the other side of the world to spread the word. One time, once, medical world has to listen to us. The medical denial is so unbelievable. If some diseases like RA or MS or SLE are provoked by Fluoroquinolones, it is as bad as if those diseases “only” mimic these diseases but are in reality FQ toxicity syndrome. Whether “real” but iatrogenic provoked, or appear to be diseases. We are suffering tremendously. Directly by FQ’s. Doctors should take care of us and take us seriously. In stead of disputing whether it is yes or no FQ linked. You know this Hippocratic oaths don’t you? I don’t feel that kind of care anywhere around me or around us.

  5. Terry Aston April 15, 2015 at 11:46 am Reply

    I sent this to Dr.Hoke. I was in contact with him a few years ago, and now in contact with him again because of this article. Remember I have seen a lot of doctors at Johns Hopkins.
    The researched you quoted from Johns Hopkins on Mitochondria is from Dr.Hoke’s lab!
    Apparently you must not have realized that when he said this is post-infectious neuropathy, it is not bacteria causing direct neuropathy, but it is an autoimmune reaction to the infection.
    Please be careful who you slander without having the correct facts. You are leading people in the Wrong Direction!

    • Lisa Bloomquist April 15, 2015 at 1:49 pm Reply

      Feel free to ask Dr. Hoke, who knows a lot about mitochondria, why he isn’t screaming about the damage the fluoroquinolones do to mitochondria. Feel free to ask him why he’s not screaming about any of the pharmaceuticals or environmental toxins that are damaging our mitochondria. Feel free to ask him about his quote which, unless it was taken out of context, showed that he was horribly misinformed about the dangers of fluoroquiolones.

      He blames an autoimmune reaction? Of course he does. Absofuckinglutely ridiculous.

      • jiwa January 31, 2016 at 2:17 am Reply

        Does the Mitochondria damage caused by Fluoroquinolone reversible? Does heavy dose of Fluoroquinolone could vanished the Neuronal Cells to the point of “gone” or lost or terminated? If could or could not, is there a path of the cell to be able to regenerate and rewire and how long to be functionally work as before?
        What about damage to CNS In Spinal Cord along toward the brain especially thalamus, hypothalamus neurotransmitters and receivers, SCN and pineal gland?

  6. Jeanie June 8, 2017 at 5:06 pm Reply

    I developed neuropathy after a course of Ciprofloxacin that I was given for a suspected UTI. My lab results, I later found out, showed no infection present in the first place.

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