Paul Hellinckx

[Paul Hellinckx @phellinckx]

Don’t prescribe #fluoroquinolones unless they are absolutely needed and no good alternatives (and there usually are at least a few). It will be very difficult to defend your practice if a patient is seriously harmed
https://t.co/uq85Tb7I1d

Someone listening @CHUVLausanne ?

[Desia Ally Joseph @DesiaAllyJoseph]

There needs to be more education regarding the dangers of fluoroquinolones, the significance of black box warnings, and the importance of obtaining written informed consent.

[Fluoroquinolone Toxicity Study @FQ_100]

UK Regulator Tightens Rules on Powerful Antibiotics After Reports of Long-Term Harm
June 2025 – London

⚠️💊The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) has strengthened its guidance on a group of antibiotics known as fluoroquinolones. These include common drugs like ciprofloxacin, levofloxacin, and moxifloxacin. The move comes after new evidence confirmed that these medications can cause serious, long-lasting, and sometimes permanent side effects in some patients.

➡️Fluoroquinolones are used to treat various infections, such as urinary tract infections, lung infections, and skin infections. However, the MHRA now says they should only be used when no other commonly recommended antibiotics are suitable. In other words, these drugs should be considered a last resort.

➡️People have reported a range of severe symptoms that persisted long after stopping the medication. These include tendon pain or ruptures, nerve damage like tingling or burning sensations, muscle weakness, severe fatigue, anxiety, depression, memory problems, and even changes in vision, hearing, or taste. Some patients have been left with life-altering conditions, and recovery has been uncertain or incomplete.

➡️Despite earlier warnings issued in 2019, the MHRA found that many healthcare professionals are still unaware of the risks or may not fully recognize the symptoms when patients present them. To address this, the agency has updated patient information leaflets and medical guidelines. It also issued safety notices reminding doctors to avoid fluoroquinolones unless necessary and to stop treatment immediately if side effects appear.

➡️The MHRA is also working with national health bodies like the National Institute for Health and Care Excellence (NICE) to spread awareness and ensure that guidelines are kept up to date. Additionally, the agency is exploring the idea of adding pop-up alerts to electronic prescribing systems to warn doctors in real time.

➡️Many patients have come forward to share their experiences. A patient group called Fluoroquinolone Toxicity Support UK (FQTSUK) collected testimonies and sent them to the MHRA. These stories revealed that some doctors were not only unaware of the risks but at times dismissed the patients’ symptoms entirely. People also expressed frustration at the lack of effective treatment options for the damage caused.

➡️The agency says more research is urgently needed to understand how these antibiotics cause such harm and how to treat it. For now, the best way to protect patients is to prevent unnecessary exposure to these drugs.

⚠️If you are prescribed a fluoroquinolone, ask your doctor whether safer alternatives have been considered. If you start experiencing symptoms like tendon pain, nerve tingling, severe tiredness, or mental health changes, stop the medication and seek help immediately. And if you’ve had problems with fluoroquinolones in the past, make sure to avoid them in the future.
The MHRA will continue to monitor the safety of these medications and may take further action if new risks are identified.

See full UK report here: https://t.co/dJd0ZGv0Jw
________________________________________
💊Medications in the fluoroquinolone class (incl: Cipro/ciprofloxacin, Levaquin (off market)/levofloxacin, Avelox/moxifloxacin etc) in all forms for humans and pets: https://t.co/OKH2DOWix0

Find support and resources on our sites:

🌐Medical resources: https://t.co/gjkZgGyJ0V
🧭Help & Misc resources: https://t.co/a63hkPq4Mv
▶️YouTube: https://t.co/lWJ0LMmfeq
🐦X/Twitter: https://t.co/Gp9ZXyhyfZ

#FQAwareness #Fluoroquinolones #MitochondrialHealth #AntibioticSideEffects #Floxed #Cipro #Levaquin #FQAD #MHRA #NICE

[Fluoroquinolone Toxicity Study @FQ_100]

A Letter Every Doctor Should Read – From a Physician Who Was Floxed by a Fluoroquinolone Antibiotic:

Over a decade ago, Dr. Todd R. Plumb, an anesthesiologist and fluoroquinolone-injured patient, wrote this heartfelt and clinically grounded letter to his fellow physicians. While more insights into fluoroquinolone-related dysfunction have emerged since then, his message remains both valuable and genuine.

Dr. Plumb speaks not only as a medical professional but as someone who personally experienced the devastating effects these antibiotics can have. His call for awareness, compassion, and informed care still resonates today and what we continue to fight for. In addition, you can also download this letter from our website under "Printable Additional Resources": https://t.co/a63hkPq4Mv

We also want to say: if you’re a healthcare professional who has been affected and are hesitant to speak out, you are not alone. We at the Foundation welcome you to reach out to us directly via our website below the references.

Dr. Plumb’s full letter✏️

Dear Doctor,
As you are probably aware, the fluoroquinolone class of antibiotics is useful for certain serious infections. Unfortunately, fluoroquinolones also have a long history of serious adverse drug reactions, many of them long term. [1] As a consequence of these reactions, several of these drugs have been removed from clinical practice or their use severely restricted. Besides the severe life-threatening immediate reactions, those of a more chronic nature may occur.

The spectrum of these adverse reactions is extremely broad. Patients suffering from these reactions are often misdiagnosed, referred for a psychiatric consult or even unfairly labeled as "difficult patients."

Many physicians have not been properly educated about the severe nature of these chronic adverse reactions, some of which result in life-long disabilities. Post-marketing studies of several flouroquinolones have shown an incidence of adverse reactions much higher than were originally reported in pre-clinical studies. [1,2,3]

You are probably aware that the fluoroquinolones are eukaryotic DNA gyrase and topoisomerase inhibitors very similar to many antineoplastic agents. Because of their similar mechanisms of action, it's no surprise that fluoroquinolones and many antineoplastic agents share similar toxicity profiles. Studies have even been conducted using fluoroquinolones to inhibit neoplastic chondrocyte growth in chondrosarcoma. [4]

There are many patients who have a syndrome of associated symptoms that include, but are not limited to:
CNS agitation, depression, insomnia, new-onset anxiety and panic attacks, and even elevated intracranial pressure and visual abnormalities. They may also present with peripheral neuropathy usually of the small fiber type with temperature and pain sensory aberrations, but also often involving larger sensory and motor nerves. Spontaneous muscle activity with fasciculations, myokymia and myoclonic jerks may also occur. Many have musculoskeletal damage with degeneration of cartilage and tendons often leading to tendon rupture and severe ongoing musculoskeletal pain long after therapy has been discontinued. [1,2,3,4,5,6,7,8]

This complex symptomatology does not usually resolve after discontinuation of the inducing fluoroquinolone and may in fact worsen. Many patients go on to have disability that may persist for years. [1] Unfortunately, such patients are often seen by many physicians from multiple specialties who, given the complex symptomatology, fail to recognize a unifying diagnosis.
The mechanism of injury is not fully apparent, but several studies have been conducted and researchers have implicated the following possible mechanisms:

1. Inhibition or disruption of the CNS GABA receptor. [9]
2. Depletion of magnesium and disruption of cellular enzymatic function. [10]
3. Disruption of mitochondrial function and energy production. [11,12]
4. Oxidative injury and cellular death. [14]

This seems to be a functional disorder and structural abnormalities are not usually seen on radiological studies. [13] Patients may have abnormal EMG/NCV studies, abnormal skin punch neurologic density and morphology, abnormal vasomotor and sudomotor function on autonomic testing, and abnormal degeneration of tendons and cartilage on MRI. [13]

There may be a large number of these patients with coexisting endocrine abnormalities including: antithyroid antibodies and abnormal thyroid function, abnormal adrenal function with either hyper or hypocortisolism, hypogonadism, hypo or hyperglycemia and possibly impaired pituitary function. [13]

Most patients suffering from these side effects have a very clear onset of symptoms temporally related to a course of fluoroquinolone antibiotic. [13] They were often given the fluoroquinolone in conjunction with a corticosteroid or NSAID. Both of these classes of medications are associated with an increased incidence of adverse drug reaction from fluoroquinolones. [10,13]

As of yet no scientifically proven effective treatment is known, however patients will definitely benefit from your caring support and appropriate informed care. Of course, other diseases with similar symptoms need to be carefully ruled out.

There exists a large community of these patients who share information on the World Wide Web. Their numbers grow as the prescription of fluoroquinolones increases. Many of these patients are professionals like myself who have been affected by these drugs. Thank you for your time and consideration.

Todd R. Plumb MD

References:

1. Cohen JS; Peripheral Neuropathy Associated With Fluoroquinolones Annals of Pharmacotherapy. 2001;35(12):1540-1547
2. Francesca Lunzer Kritz; New Cipro, Same Side Effects, Washington Post, December 24, 2002.
3. Shepard CW et al; Antimicrobial Postexposure Prophylaxis for Anthrax: Adverse Events and Adherence Emerging Infectious Diseases ¡E Vol. 8, No. 10, October 2002
4. Fox EJ et al; The effects of ciprofloxacin and paclitaxel on metastatic and recurrent chondrosarcoma COMMUNITY ONCOLOGY November/December 2005
5. Physisicans Desk Referfence 2006
6. de Bazignan DA etal; Psychiatric adverse effects of fluoroquinolone: review of cases from the French pharmacologic surveillance database[Article in French] Rev Med Interne. 2006 Jun;27(6):448-52. Epub 2006 Mar 9
7. FDA Medical Bulletin * October 1996 * Volume 26 Number 3. Reports of adverse events with fluoroquinolones
8. Saint F. etal; Tendinopathy associated with fluoroquinolones: individuals at risk, incriminated physiopathologic mechanisms, therapeutic management [Article in French]. Prog Urol. 2001 Dec;11(6):1331-4.
9. De Sano A. etal; Adverse Reactions to Fluoroquinolones. An Overview on Mechanistic Aspects Current Medicinal Chemistry 2001, 8, 371-384 371
10. Stahlmann R. etal; Effects of magnesium deficiency on joint cartilage in immature Beagle dogsimmunohistochemistry, electron microscopy, and mineral concentrations, Archives of Toxicology. Jan. 2000 73(11,12)
11. Hayem G. Cytofluorometric analysis of chondrotoxicity of fluoroquinolone antimicrobial agents. Antimicrob Agents Chemother. 1994 Feb;38(2):243- 7.
12. Kozie[lstrok]; Ciprofloxacin reduces mitochondrial potential and inhibits calcium entry into Jurkat cells
R European Journal of Biochemistry 2003; 1 Supplement 1 July: Abstract number: P4.8-33., Zab[lstrok]ocki K., Szczepanowska
13. https://t.co/VxFZ2JHQIW
14. Simonin MA etal. Pefloxacin-Induced Achilles Tendon Toxicity in Rodents: Biochemical Changes in Proteoglycan Synthesis and Oxidative Damage to CollagenAntimicrobial Agents and Chemotherapy, April 2000, p. 867-872, Vol. 44, No. 4

💊Medications in the fluoroquinolone class (incl: Cipro/ciprofloxacin, Levaquin (off market)/levofloxacin, Avelox/moxifloxacin etc) in all forms for humans and pets: https://t.co/OKH2DOWix0

Find support and resources on our sites:

🌐 Medical resources: https://t.co/gjkZgGyJ0V
🧭 Help & Misc resources: https://t.co/a63hkPq4Mv
▶️ YouTube: https://t.co/lWJ0LMmfeq
🐦 X/Twitter: https://t.co/Gp9ZXyhyfZ

#FQAwareness #Fluoroquinolones #MitochondrialHealth #AntibioticSideEffects #Floxed #Cipro #Levaquin #FQAD

[Theriaque_officiel @Theriaque_CNHIM]

Risque d'#anévrisme ou de #dissection aortique accru avec les #fluoroquinolones par rapport aux macrolides dans une nouvelle étude
https://t.co/TeJxjsl54z
https://t.co/3Uv60Lz8Bg

[Epitomax 💊 🐍 @Topiramatee]

@Claraelsan Si on prend les fluoroquinolones, c’est une classe d’ATB qui est loin d’être anodine en termes d’effets secondaires : affections des tendons et même des vaisseaux avec des cas de dissection aortique.

[fereshteh jahanbani @fereshtehjahan1]

Reaching out to anyone interested in supporting our work on fluoroquinolone toxicity and its impact on connective tissue and mitochondria, and whether the damage is reversible. Please help fund this preliminary yet groundbreaking research #Fluoroquinolone #MECFS #hEDS, @FQ_100

[ANSM @ansm]

Les #fluoroquinolones exposent à des effets indésirables qui peuvent être graves, invalidants et potentiellement irréversibles

👉Nous rappelons l’importance de leur bon usage

Informations pour les patients et les pro de santé : https://t.co/KX0pk5R4v6

[DrSeb @Sebbyy78]

@gardonslasante J'ai déjà eu un médecin mettre une fluroquinolone chez une femme, pyolo, alors que tout les atb était sensible, parce qu'il voulait "taper fort". On est aussi là pour rétablir les erreurs de jugements (a plusieurs cerveaux on est plus performant)

[Coville Philippe @CovilleP]

@freddessort Les profonds effets toxiques des #fluoroquinolones est une épidémie silencieuse notre association a regroupée près de 750 victimes dont de nombreuses personnes handicapées à vie @HAS_sante @ansm https://t.co/95V2q6vig2

[Fluoroquinolone Toxicity Study @FQ_100]

A doctor’s visit for #fluoroquinolone #antibiotic toxicity remains a huge challenge for all of us as we grapple to be heard, and our systemic issues taken seriously. This ‘Dear Doctor” letter along with its references, may be a useful tool to help with that conversation until the ICD10 medical codes go into effect next October.

see download towards the bottom of this page: https://t.co/a63hkPq4Mv

[Coville Philippe @CovilleP]

@DrJeromeMarty Il y a aussi de très nombreux médecins qui continuent de prescrire antibiotiques de la famille des #fluoroquinolones pour syndromes grippaux risquant endommager à vie santé des patients. Les FQ c est très toxique. Cette situation est extrêmement grave et fait des blessés graves

[Emma Clifford Bell @sunnygovanemma]

Campaigners raising awareness of these rare but severe reactions call this ‘being floxed’ #floxies #fqad #floxed

[Julie Browers @BrowersJulie]

@BBCScotlandNews Same here. Cipro left me disabled and suffering with unbearable pain. I continue to meet people with permanent damage from FQ’s just in my little neighborhood alone. The “it’s so rare” speech is getting old. Please read the warnings - serious ADRs from Cipro are far from rare.

[BBC Scotland News @BBCScotlandNews]

Antibiotic side effects left me barely able to walk https://t.co/7UCpJPAmEh

[Gabriel BIRGAND @GBirgand]

In France, prescribing oral alternatives to Fluoroquinolones for females may be possible in ≥99% of E. coli acute pyelonephritis cases in the community, ≥98% in Nursing Homes. @SantePubliqueFr @ReJIF_ @SPILF_ @jac_amr @BSACandJAC @ESCMID
https://t.co/QBm0yEMo2v

[Dr. Nancy Olivieri @DrNancyOlivieri]

"One of my favourite studies asked MDs if they were influenced by small gifts from #Pharma. Most said no.
When asked whether their colleagues were influenced by the same small gifts, most said yes."
Always🩷 that one too, @mgtmccartney 🤣
This is 🎯: https://t.co/6qB8mz5dCo

[Boston 25 News @boston25]

Advocates: CDC approves ‘floxing’ as reportable medical diagnosis https://t.co/xbGeOoB37m

[Jen @carfraej1]

@KarenLorre “The highest concentration of antibiotics in water and sea sediments, with a frequency of 49%, was related to fluoroquinolones. In rivers, sulfonamides had the highest abundance (30%). Fluoroquinolones (with34%) had the highest concentration in lakes.”

https://t.co/K2esiuM8Hf