Antibiotics used to treat Lyme disease may double the risk of permanent nerve damage, according to a new study published in the journal Neurology. Cipro, Avelox and Levaquin are not the first line of attack for Lyme disease but shortages of doxycycline and rising prices of this popular drug may mean that more people than before are susceptible to this risk of neuropathy.
The antibiotics, which are known collectively as fluorquinolones, have previously been linked to liver disease, retinal detachment and kidney disease but this is the first time that the link has been made between ciprofloxacin, mocifloxacin and levofloxacin and peripheral neuropathy.
As Lyme disease symptoms can include nerve pain and paraesthesia it may be that the risk is even higher for those being treated with these drugs for Borreliosis as signs of nerve damage may be masked by the symptoms of the condition, allowing inappropriate treatment to continue unchecked. Some people taking ciprofloxacin have experienced swelling of the joints, including tendinitis, which could appear similar to Lyme arthritis symptoms.
What Are Fluorquinolones?
Fluorquinolones are one of the most commonly prescribed antibiotic classes and are typically used to respiratory infections and urinary tract infections. The potential side effects of these drugs led to the FDA issuing a mandate to label the medications with a warning noting that there had been reports of peripheral neuropathy, which causes muscle weakness, numbness and pain with their use.
The new research looked at a decade’s worth of medical records for around a million American men aged 45-80 and found those men who had been diagnosed with peripheral neuropathy. They then looked to see if these men had been prescribed fluorquinolones and compared them with case controls and men prescribed finasteride, a drug that is not linked to nerve damage.
What the researchers found was that men who took fluorquinolines were twice as likely to develop peripheral neuropathy, especially if they were taking the drug for the first time. Mahyar Etminan and colleagues at the University of British Columbia identified 6,226 cases of peripheral neuropathy and compared these to 24,904 controls. Those currently using fluorquinolones had a relative risk of 1.83 of developing peripheral neuropathy, i.e. they were almost twice as likely to develop the condition compared to those not taking fluorquinolones. Those using the drugs for the first time were more than twice as likely to develop peripheral neuropathy (RR 2.07).
Fluorquinolones and Retinal Detachment
The researchers studying this connection were also the ones who had earlier noted 445 cases of retinal detachment in 989,591 people visiting an ophthalmologist after taking fluorquinolones in BC, Canada. Health Canada issued a warning about the medications after these findings were released but many physicians continue to prescribe the drugs because they are highly effective for a range of infections.
Fluorquinolones have a broad spectrum action and are easily absorbed meaning that they are comparable to intravenous antibiotics and can combat a lot of different bacteria. For people with Lyme disease, who often have co-infections such as Babesiosis and Bartonella, this almost blanket coverage of pathogenic bacteria is especially helpful.
Rapid Onset of Peripheral Neuropathy with Cipro and Levaquin
Earlier research, published in 2001, noted that the onset of peripheral neuropathy is usually rapid with the use of fluorquinolones (Cohen). The researchers looked at mentions of this side effect on internet forums in order to find cases and concluded that almost three quarters (71%) of cases had involved symptoms lasting more than three months, with 58% lasting more than a year. A third (33%) of cases saw symptoms occur within 24 hours of beginning treatment with fluorquinolones, 58% occurred within 72 hours, and 84% occurred within the first week of taking the drugs. The most commonly prescribed antibiotic in these cases was levofloxacin (33/60 cases), with ciprofloxacin second (11/60). In eight cases the same antibiotic was prescribed twice, suggesting that physicians were unaware of the link between peripheral neuropathy and fluorquinolones.
For many patients the use of fluorquinolones allows them to stay out of hospital as they can avoid IV antibiotics, but for people with Lyme disease these drugs are not the first line treatment and with Borreliosis already increasing the risk of permanent nerve damage physicians are being warned to be extra cautious about prescribing such medications.
Cohen JS. Peripheral neuropathy associated with fluoroquinolones. Ann Pharmacother. 2001 Dec;35(12):1540-7.
Etminan, M., Brophy, J.M., Samii, A., Oral fluoroquinolone use and risk of peripheral neuropathy: A pharmacoepidemiologic study. Neurology, Published online before print August 22, 2014, doi: 10.1212/WNL.0000000000000846.