In 2005 the FDA changed the package insert for Cipro [8] to acknowledge the tendon ruptures and the development of irreversible neurological conditions.

ARE YOU POISONED BY A FLUOROQUINOLONE ANTIBIOTIC?

If you have taken a course of any quinolone or fluoroquinolone antibiotic (Cipro, Levaquin, Floxin, etc¼) you have been chemically poisoned. Depending on individual conditions, and the dosage and length of the treatment, the intoxication will range from very mild and asymptomatic to very severe and disabling.

In a minority of cases, the patient notices the reaction immediately. In a vast number of cases, most symptoms, or at least the most severe ones, emerge during the last stages of the treatment, or weeks or months after the completion of the quinolone treatment.

Sedentary people tend to notice less adverse reactions because they do not use their body to full active capacity. Taking into account that at least one third of QTS presentations are predominately tendon-related or musculoskeletal, damage to their tendons, cartilages and muscles remains unnoticed.

Almost everybody can take low doses of quinolones without developing any symptoms of an adverse reaction (for instance, 250 mg daily of cipro for two weeks). Many people can take a 7-day course of a medium dosage of quinolone antibiotics (for instance, 750 mg daily of cipro) without perceiving any adverse effects. For higher doses (for instance two weeks of 1.000 mg of cipro), most people are also asymptomatic during their first treatments (remember that the damage is cumulative). For these latter doses, their cartilage, tendons, nerves and small veins and arteries have been directly damaged but not enough to make them symptomatic. That is the case of many sedentary people who deeply damage their joints as a result of repeated but short courses of quinolones. But the fact remains unknown to them since they are asymptomatic, and they do not use their joints beyond the pain threshold. Later in life, it manifests as early osteoarthritis, collagenous deterioration, or nervous system failures. In any case, this paper is not intended for these people.

Look to the following medical paper that seems to support the generalized toxicity caused by quinolones that we have been postulating since long ago:

JEREMY NORMINGTON, DPT, IS DIRECTOR OF PHYSICAL MEDICINE AND REHABILITATION AT SIOUX VALLEY MEMORIAL HOSPITAL IN CHEROKEE, IOWA

Another study by Koeger et al. looked at tendons of asymptomatic fluoroquinolone users. Researchers observed hypersignals that indicated common increased cellular activity (4-out-of-10) in tendons of asymptomatic patients. This suggests that tendon metabolism is altered in the absence of clinical signs.

Many of us were healthy young athletes in perfect health with rock solid knees and hips prior to taking quinolones, but now have become crippled persons, with our cartilages half destroyed, our eyes barely functional, our bodies aching since several years ago and our whole lives stolen from us by a medical class that now turns its back on us.

For those that have developed symptoms like the ones described later, first of all, they have to check if they have ingested any quinolone antibiotics during the last three or four years. The damage caused by the quinolone antibiotics becomes evident at a point in time that ranges between the moment of the treatment itself from up to eighteen months later. If your symptoms fit with any of the categories listed later in this article, and you have taken fluoroquinolones in the past, then a quinolone induced intoxication might well be the reason for all of your recent physical problems. This report could help assist you in reaching a diagnosis.

27. SOME MEDICAL TERMS AND INFORMATION

This paper intentionally has a non-medical quality. However, it is necessary that you become familiar with a few technical facts regarding the floxing syndrome. Some are explained throughout the report, when they are needed. A brief introduction to the general aspects of an adverse drug reaction is included here.

The terms drug allergy, drug reaction and some euphemisms (hypersensitivity, intolerance) are often used interchangeably. If we take into account the immune response of the patient, a drug allergy can be restricted to the reaction in which special antibodies of the IgE type are massively released. This report does not cover allergic reactions.

Drug reactions can be classified as follows:

Some classifications have been established in order to help discern among drug IMMUNE reactions:

Like many other drugs, quinolones can cause an immunologic type I reaction, plus many non-immunologic primary pharmacological side effects (insomnia, restlessness, caffeine intolerance) and secondary pharmacological side effects (thrush, leaky gut). They can also interact negatively with many drugs. But their distinctive actions are probably due to their direct toxicity and the subsequent immunologic reaction.

In most cases, there are not any markers that can confirm a diagnosis, so all serum (blood) parameters can be normal and one can still be suffering from a very severe and incapacitating reaction. Only a very specialized and often inaccessible (in most healthcare systems) tissue biopsy can confirm the problem and even then the probable denervation and cell degeneration shown will be classified according to standard methods and fit partially into already known diseases. Therefore, without a biopsy, most diagnostics are established upon clinical symptoms. In principle, the fluoroquinolone syndrome can be classified as a TYPE III immunological reaction, with an added non-immunologic TOXICITY.

One thing is clear: re-exposure to quinolones, after having been floxed previously, poses very high health risks for the patient. Persons that become floxed twice have the worst prognosis (expected outcome). Many people with moderate reactions to quinolones are later re-exposed to another round of the same antibiotics by their doctors that dismiss their complaints about pains and disorders associated to the antibiotic. The outcome is frequently a severe reaction that lasts 3 to 6 years and ends up with permanent injuries.

The following study demonstrates that more than half of 55 patients with immediate adverse reactions (taken place during the treatment), had immunologic IgE specific for quinolones, circulating in their blood, up to 4 years after the treatment. The report also concludes that if you have suffered a reaction to a quinolone, you have to avoid all quinolones, as we know. In our opinion, this test should be considered standard practice to detect many cases of reactions to quinolones, to provide ignorant doctors with a tool for diagnosis, and to check the evolution of the reaction, by measuring the concentration of those specific IgE markers. Nevertheless, most floxed persons seem to have a response more founded on IgG than on IgE. Very likely, more studies like this one could focus on the problem with minimal effort.

DETECTION OF SPECIFIC IGE TO QUINOLONES.
Manfredi M, Severino M, Testi S, Macchia D, Ermini G, Pichler WJ, Campi P.
Allergy Clinic and Laboratory, Nuovo Ospedale San Giovanni di Dio, Florence.
BACKGROUND: In the last years, immediate reactions to quinolone antibiotics have been observed with increasing frequency, mainly urticaria, angioedema, and shock.

OBJECTIVE: We sought to assess whether these reactions are IgE mediated and whether an in vitro test for quinolone-specific IgE is useful in the diagnosis and understanding of cross-reactivity.

METHODS: We assayed specific serum IgE to quinolones using epoxy-activated sepharose 6B as the solid phase in 55 patients with immediate adverse reactions; specificity of IgE binding was demonstrated by inhibition tests.

RESULTS: The test yielded positive results in 30 (54.5%) patients who were tested 1 to 48 months after the reaction had occurred. The quinolone-specific IgE seems to disappear more slowly in atopic patients. The cross-reactivity between various quinolones allowed us to identify a common structural motif within quinolones that might be responsible for clinical and serologic cross-reactivity.

CONCLUSION: A substantial portion of immediate reactions to quinolones appear to be IgE mediated. Cross-reactivity of IgE among different quinolones is frequent and suggests that a common avoidance of quinolones should be attempted in all patients with respective symptoms.

28. WHAT KIND OF DAMAGE DO QUINOLONE ANTIBIOTICS CAUSE?

This class of antibiotics has very characteristic ways of causing injuries:

      quinolones damage the central and peripheral nervous systems

      quinolones damage small veins and arteries (vascular disorder of the vasa vasorum and vasa nervorum) and the surrounding matter of all organ cells (extra-cellular matrix)

      quinolones impair the rebuilding and repairing capacity of tissues, specially connective-collagenous

      quinolones chemically destroy important structures, like cartilage

There are many other mechanisms of quinolone assault on the human body (for instance, liver, kidney, pancreas and heart reactions, all of which can be serious or even fatal), but they are not the focus of the present report.

29. HINTS AND CLUES THAT MIGHT SAVE YOUR LIFE

Perhaps you have taken quinolones in the past and you think that they worked well and that you did not react negatively to them. Check the following subtle symptoms of the beginning stages of a quinolone intoxication from an earlier treatment and the normal interpretations that people make of them.

      You had a strange bout of tendinitis, for instance in the outer tip of the hip, normally diagnosed as trochanteric bursitis caused by tight belts or resting on you side at night. The same applies to other areas of the body, like the elbow (epicondylitis) diagnosed as an overuse of your tennis racquet or gardening practices, but you remember that you had never had it before.

      It takes you longer to recover after exercise. It is not alarming and you have not paid much attention to it.

      You sleep worse than before; it seems normal as you have a lot of pressure at work.

      From time to time you have some small throbbing pains in different parts of the body. They last only for a few seconds, so there is nothing to worry about it.

      It is strange- but you have occasional twitching in an eyelid, or any other part of the body. It is not painful.

      Some nights you feel some mild itching migrating along your body. One brief itch here and another there. It is more intense in the scrotum or groin. Instead of identifying it as a peripheral neuropathy, you conclude that your clothes, your perspiration or the new brand of soap that is more irritating must be causing it.

      You feel some stiffness, and your range of movement is not as full as before, especially in one or both legs, but it is normal because you are getting older.          

      You do not tolerate coffee as well as before. Now you have to reduce the amount of coffee that you used to drink.

      Your memory is not as good as it used to be. The cause may be too many things to think about and too much stress.  And you are no longer a young person.

      There is an urge to urinate when the bladder is partially full. When you feel the need to urinate you have to rush for the toilet. Most urologists think that it is due to a dysfunction associated with a benign enlarged prostate but in reality it is a neurological deficit caused by the prescriptions of quinolones that they gave you.

      You cannot flex fully, or strongly, your big toe (one or both), or sustain the flexion for more than a few seconds. This is an indication that your large nerves (anterior tibialis) have started to fail due to the toxicity. This sign is a strong warning that your body will not tolerate more quinolones.

      Some times, you have nightmares while falling asleep that scare you. How strange you think. They are toxic panic attacks that reflect toxic damage to your brain.

If you have experienced some of these symptoms since you took your first quinolone, perhaps you have reached your first threshold of tolerance, that -once surpassed- can result in the destruction of your life soon thereafter if you take more quinolones.

30. WHAT ARE THE MAIN SYMPTOMS OF BEING POISONED BY A QUINOLONE?

Getting floxed is just getting intoxicated, or poisoned. The toxic agent (the quinolone compound) enters the blood stream and spreads throughout the body. The defenders of the quinolones are even proud of the big penetrative power of the drug, that reaches delicate organs like the brain that are very well shielded against most chemical compounds. Therefore, it is not surprising that symptoms of the toxicity arise over all body areas and systems.

For a complete list of symptoms, see later in the report. A strong reaction generates some 30 to 50 symptoms. In some cases adverse reactions appear right after the ingestion of the antibiotic. In intermediate and severe reactions you may start with a few symptoms and as time passes new and debilitating symptoms arise, especially around the second, sixth and ninth months mark post-floxing. And in many cases of young, very healthy and active people, the worst injuries emerge progressively up to eighteen months or more after the cessation of the drug (we have deducted it beyond any doubt from various crystal-clear cases plus several unwilling re-exposures with quinolones). There are many medical articles as well, that state that a lot of the drug induced symptoms start some weeks to months after completing the treatment.

Here we include the most easily recognizable and common symptoms in three groups. Please take into account that the heading of the three groups is only for orientation purposes and to make the text more intuitive. Some of the disorders are cyto-toxic or vascular, for instance, and the headings do reflect that fact. Some injuries have a multiple root like eye damage that can be muscular, neurological, vascular and toxic but are included just in one group for the sake of simplification.

Joints and muscles:

­          Arthralgias (pain in joints) especially the tendons of the feet, ankles, knees, hips, elbows, shoulders, wrists, neck. Pain of different kinds, very frequently migrating around a joint and then moving to other joints over time. Pains are bearable sometimes but they often are very debilitating, requiring almost absolute rest for months because patients cannot walk at all or more than a few paces or stand up for long. Even if the patient is functional, pains have a neurological root and can be very intense and interfere with normal activities and prevent sleep. These arthralgias evolve to osteoarthritis in many cases with cartilage erosions. The arthralgias start as early as during the antibiotic treatment. In other cases arthralgias show mildly at the beginning and their intensity increases to its maximum intensity up to a year and a half later. For athletes with this type of delayed reaction, a medium level of pain can be constant but some six hours after exercise the symptoms may be present as acute pains that can be excruciating if the limit of tolerance is reached. This limit consists of the maximum exercise that a given body can tolerate before its impaired repairing capacity is overwhelmed by the physical demands. For the average floxed athlete, this limit is much lower than it was before the quinolone intoxication. The joints, fingers or toes can also become inflamed and appear red and feel hot.

­          Pains in different areas of the body not considered main joints. Pains tend to be generalized and migrating. Can be mild or very intense. Common areas affected are the back, neck, head (jaw, skull zones), chest (breastbone), groin, testes, plantar fascia (sole of feet) and others. They can be very debilitating. Pains in many muscles over the body (myalgias), that cause a lot of stiffness and soreness. These pains are of every kind, like diffuse, acute, throbbing, pulsating, vibrating, burning, shooting, stabbing, dull, deep, tremors, and many times they increase at night. A floxed person can feel pains at all times, even while resting and walking, changing positions when sitting, being unable to cross legs or make some body movements. In severe cases the pain lasts for five to six years on average.

­          Acute tendinitis over different parts of the body very similar to normal types of tendinitis but different in its persistence and unresponsiveness to conventional treatments. This type of tendinitis is very acute at times, requiring immobilization, and is nearly always triggered by a level of use that was normal in the pre-floxed state, or normal daily use. The tendinitis does not respond to anti-inflammatory medication, which in fact, can make the symptoms worse. Sometimes the tendinitis 'migrates' within a joint and from one joint to others, which merely reflects that all tendons are equally affected and that the ones used most are the ones that fail and experience pain and damage. In the first stages of the floxing, the tendinitis is predominantly enthesitis, which is inflammation of the insertions of muscles and tendons into the joints. In many cases they end up in partially or fully ruptured tendons (achilles, shoulder rotators, wrists flexors). It is a class effect of all quinolones, in other words, all these antibiotics are very toxic for all the tendons in the body, for everybody. For every one the quinolones cause small and multiple injuries in the tendons, that eventually rupture in those people unlucky enough having weak tendons, having taken corticoids, having pre-existing vascular problems (pre-diabetics) or being magnesium deficient. Long- term floxed persons, usually affected by a severe reaction still have tendinitis in critical areas of the body 4 or 6 years post-floxing. Very typical long term tendinitis are: plantar fascia, achilles tendon, posterior tibialis complex, toe flexors, insertions of knee’s tendons, both ends of the ileotibial band, iliopsoas area, shoulder rotators, elbow epicondyle, forearm and wrists.

­          Arthritis-like symptoms. Many symptoms resemble those of rheumatoid arthritis and other autoimmune diseases, but are always sero-negative and with a different pattern of clinical symptoms. Reiter's is a common diagnosis for many floxed persons, even if they do not have the HLA-B27 antigen.

­          Osteoarthritis-like symptoms. Joints usually start to make a lot of noise. After the intoxication, and with time, healthy cartilage becomes softened and erosion takes place, and the illness presents itself as a true clinical osteoarthritis. Knee cartilages are specially targeted by quinolones, with a very high incidence of torn menisci (inside the knee). There are many cases of complete destruction of previously healthy joints and the patient has to be submitted to very invasive surgical procedures and or total joint replacement. The most damaged cartilages are the most weight bearing ones: knees, hips and low spine. Cartilages of people that have taken several short-term quinolone treatments, as well as cartilages of those that have taken prolonged courses or high doses, have a very decreased bearing capacity. Fluoroquinolones rarely can cause osteonecrosis of the femoral heads and other areas, requiring total joint replacements.

­          Permanent stiffness that exhibits a clear loss in range of movements, especially with legs and arms, but that can affect the whole body. The most affected joints are the hips (adduction, abduction, flexion and extension), knees (flexion, adduction), and shoulders (extension). Increased stiffness after exercise.  It takes longer to recover from exercise, and there is a clear loss of flexibility. Soreness in many muscles, especially legs and shoulders, and also a predilection for the neck. Weird sensations in the muscles and joints. Clear feeling that something is going very wrong.

­          Shallow breathing that causes a deficit of oxygenation that complicates insomnia, recovery and other reactions and metabolisms in the body. During the acute phase the floxed persons can have a sense of not grasping enough air and subsequent sense of dying.

­          Very slow recovery from impacts and blows. Whenever the affected person is hit in athletic or daily activities, the flesh takes much longer to recover from the pain, along with increased haemorrhaging and inflammation. Dark veins, haemorrhage-like patches under the skin.

­          The skin (and other collagenous tissues) loses nearly all capacity of recovery. A cut on the skin near an affected joint leaves a pink scar for many months afterward whereas it would have become unnoticed in a pre-floxing state.

­          Cold feet and hands. The presentation resembles Raynaud's syndrome. In many severe cases several phalanges of fingers turn numb or become close to frozen with cold conditions that did not cause any trouble before the floxing. Loss of sensitivity in hands and feet. Increase in the shape or depth of vertical ridges in fingernails. Pains in the nails of the big toes that feel as if they were about to fall apart.

­          Chest pain. Heartburn. Tight chest.

­          Weight loss, probably due to muscle destruction and atrophy and alterations in intestinal function. The weight loss reaches 15% of total weight in many cases, which is very hard to put back on again. Typically, people loss up to 15% of their weight at the start of the bottom line of their reactions, and then recover some 8 or 9% of it during the beginning of the recovery phase. The last 6 or 7% of the weight is difficult to get back and only happens when the healing is almost complete. Originally, thin people also lose the same amount of weight. This loss is muscle mass mainly.

Central and peripheral nervous system and systemic:

­          Brain fog, depression, depersonalization, short-term memory loss, and lethargy. Slurred speech. Inability to speak fluently. Forgetting words, getting stuck in the middle of a sentence. Some are caused by the insomnia but it is mainly a neurological injury of the brain. Headaches, especially unilateral, or affecting one side only. Foggy mind, drowsiness, lethargy, loss of drive and power. Need to sleep. Tiredness and intense fatigue. Crying episodes. Loss of balance, strong feeling of being rocked back and forth and that everything is moving.

­          Twitching, numbness, sensory disturbances, burning on the skin, trembling, throbbing, pins and needles sensations, and pulsating pains in muscles and joints are the hallmark of this disease; especially in the lower legs (ankles, Achilles, calves, thighs and knees) arms and hands, but can manifest all over the body. Fasciculations (visible crawling under the skin) of muscles, due to denervation, a very serious neurological symptom. Twitching is manifested earlier in eyelids and the triangle on the back of the hand placed between the thumb and index finger before it can affect the whole body but later spreads all over the body. Some days a floxed person can have hundreds of series of twitching all over the body.

­          Burning skin, very common, burning lips, buzzing and all sort or weird feelings over the whole body. Gum numbness.

­          Insomnia, very acute and difficult to deal with. Restlessness, great loss of sleep quality. Intolerance (great nervousness or increasing symptoms) to concentrated coffee (espresso) and tea. Intolerance to coffee can be present for more than 7 years (probably forever, but we only have abundant data of people up to 7 years out). Insomnia can last more than 4 years during which is difficult to get more than a few hours of disrupted and bad quality sleep. Anguish, depression, pre-seizure state. During some part of the floxing most people experience anxiety and panic attacks (awakening amidst strange nightmares with fear and a feeling of dying), especially at night or when falling asleep, but also while being awake.

­          Vision problems. Diplopia (double vision) and other focusing problems. Over-scanning eyesight (swirling focusing). Large amount of floaters (dark worm, cobweb, string or spot like) that seem to float in the vitreous area of the eyes. Also ziggies (brilliant minute lights that move in a zig-zag or wavy, wandering manner in your field of vision). Sparks (flashing lights). Halos and curtains of watery sight in the upper part of the field of vision that move sideways along with your eye. Waves-like in the outer margins of the sight. Acute photophobia or intolerance to strong sunlight or artificial light. Complete or partial loss of vision (transitory, but lasting up to 6 minutes as absolute blindness seeing only solid white). In extreme cases, complete irreversible blindness has been documented in medical papers. Eye pain, ocular pressure, blurred vision. Loss of vitreous acuity. Cataracts, macular degeneration. Quinolones cause degeneration of the retina, especially the outer margins. In many cases, some very worrisome implications such as dry eye syndrome are also experienced. Dry eye can render zero mm of tear absorption in the Schirmer’s test. Vision damage reaches its peak about two to six months post-floxing and lasts for years or becomes a permanent injury, being a marker of the likelihood of recovery (i.e. the drier the eye and longer lasting, the lesser are the chances of overall recovery). Vision damage caused by quinolones has a high ratio of irreversibility. Severe reactions have nearly always associated some degree of damage on the vision that is invariably assessed by the patients as very disabling. We have seen so many, really a great many, cases of irreversible damage of vision, or injuries not cured by the 5^th year mark, and the distress inflicted on the sufferers, that this alone would be enough cause to withdraw all the quinolones from the market for primary care treatments.

­          Diminished erectile function (semi-impotence). Difficulty to reach hard erections. Decreased sex drive (libido) both for men and women. Can last more than three years in severe reactions for young people that were very healthy and active sexually pre-floxing.

­          Digestive problems. The quinolones damage the entire nervous network governing the intestines. Alteration of intestinal movements. Intolerance to foods and many compounds. Bad reactions from defectively digested foods. Inability to absorb some nutrients, especially minerals. Weight loss. Destruction all of the flora and proliferation of bad fungi like candida.

­          Violent rectal (anus) pain and spasms that may cause fainting. Spasmic pains of every sort and intensity in every part of the body: skull, lower head, neck, jaw, shoulders, arms, back, hips, legs, ankles, fingers and toes.

­          Trembling of a limb after sustaining tension with the muscular groups of that limb. For instance, trembling of the leg after toe raising for a while, or an inability to write steadily after holding a heavy load with that hand.

­          Tinnitus, or ringing in the ears. Ear pressure, usually in waves of pressure. Hypersensitivity to normal sound. Headaches, head pressure, mainly asymmetric. Hearing loss that can be permanent.

­          Heart palpitations and strange pounding and throbbing. Skipped heart beats. Alterations of heartbeat. Irregular heartbeats are usually more common after eating. The heart palpitations and arrythmias are some times life threatening. A serious heart condition called prolongation of the QT-interval is a class effect of all the quinolones, showing once more that they are very defective drugs. Some times floxed persons require the implantation of pacemakers. Many thousands of people die from heart attacks that are not of an infarction kind but cardiopathical, caused by deffective nerve signals. Most all of them are caused by toxic compounds, like environmental hazards or medications, among them the quinolones (none of them are attributed to the real cause).

­          Neuropathies in limbs, with a lot of pain with muscle wasting and nerve involvement. In many cases they resemble muscular injuries. For instance, a femoral (upper leg) nerve neuropathy can be considered a pull in the hamstring; a peroneal nerve neuropathy can be disguised as an ankle strain, or an overuse syndrome and so on. These neuropathies have a rapid onset and grow in intensity for many months. In many cases it takes several years to get a remission of these neuropathies.

­          Alterations of liver, kidney and pancreas enzymes and parameters. While taking quinolones the cholesterol and tryglicerides skyrocket up to three times their normal values, to return to normal range in a few weeks. Quinolones also provoke hypo- and hyperglycemias as a class effect. The quinolones accelerate the progression towards full diabetes of those individuals with an unrecognized pre-condition.

Autoimmune like responses:

The main symptoms of a quinolone poisoning resemble those of some autoimmune disorders because in acute intoxications they cause a type of small vessel vasculitis with neurological dysfunction:

­          Dry eye, dry mouth, dry sinuses, dry ear and a shift towards dry skin. Dry eye can be measured with moisturizing stripes rendering null values in severe reactions. Sticky, gritty eyes. Dry eye can have serious consequences if not treated. Dry mouth, especially at night or when taking any vasodilator. Dry sinuses cause many infections that are also opportunistic due to the compromised immune system of the severely floxed persons. Dry ear turns the protective earwax into a sort of useless sand dust. Decreased semen production. Many doctors insist on diagnosing floxed persons with Sjögren's.

­          Problems with foods and drinks. Your intestines are also altered and their permeability and ability to process foods is impaired.  Abnormal intestinal function, food intolerances, chemical disturbances, cycling of symptoms and general malaise. Increased sensitivity to chemicals, especially to quinolone-tainted foods (poultry, beef). Sensitivity to perfumes, health care products and chemicals. Taste and smell perversions. Lack of sense of smell.

­          Cycling or relapsing of symptoms. After the acute phase, nearly all recoveries experience cycles of improvement and relapses.

­          Endocrine alterations (hormones basically), with skewed ranges for cortisol, thyroid hormones and others, causing all the associated symptoms.

­          Symptoms of hypo and hyperglycemia, due to deregulation of the sugar metabolism.

­          Many symptoms that resemble fibromyalgia, multiple sclerosis, lupus erythematosus, lyme, rheumatoid arthritis, reactive arthritis, vasculitis, AIDS and other diseases.

­          Skin rashes, especially in distal areas (hands, ankles). Itching, all over the body, with little intensity, plus more intense in some specific areas (hips, for instance) when taking a hot shower, plus itching in the groin and scrotum at night when hot. Reddish or red-blue upper eyelids. Increase in vertical ridges in nails of toes and fingers.

31.TYPICAL ADVERSE REACTION LIST OF A QUINOLONE ANTIBIOTIC

While the above listings reflect the most typical symptoms of a fluoroquinolone intoxication, nearly all floxed persons do exhibit a wide range of abnormalities, many of which are included in the official list of potential side effects of any fluoroquinolone.

The following is the list of typical reactions observed during fluoroquinolone therapy. The list is an official one. It is comprehensive, but does not mention the severity of the reactions, and also, the percentage of people affected has been manipulated to appear as very low, when indeed it is much higher. Underlined are the reactions experienced by people related with this report.

Pregnancy Risk Factor and Implications: Category C, is excreted in human milk, potential for serious adverse reactions in nursing infants.

Contraindications: Do not use if you have a known allergy to ciprofloxacin or to any member of the quinolone class of antimicrobial agents.

Warnings/Precautions: The safety of this drug in pediatric patients, people less than 18 years old, pregnant and lactating women has not been established. This drug may cause cartilage erosion of weight-bearing joints. This drug may also cause convulsion, intracranial pressure, toxic psychosis, and it may cause central nervous system events. Use with caution in patients with CNS disorders or in patients with risk factors such as certain drug therapies and renal dysfunction that may predispose them to seizure or lower their seizure threshold. Serious and fatal reactions have been reported in patients receiving concurrent administration of ciprofloxacin and theophylline. Serious and occasionally fatal hypersensitivity reactions have been reported in patients receiving quinolone therapy. Severe hypersensitivity reactions characterized by rash, fever, eosinophilia, jaundice, and hepatic necrosis with fatal outcome have also been rarely reported in patients receiving ciprofloxacin along with other drugs. Pseudomembranous colitis has been reported with nearly all antibacterial agents including ciprofloxacin, and may range in severity from mild to life-threatening. Treatment with antibacterial agents alters the normal flora of the colon. Achilles and other tendon ruptures that required surgical repair or resulted in prolonged disability have been reported with ciprofloxacin and other quinolones. Avoid excessive sunlight as moderate to severe phototoxicity manifested as an exaggerated sunburn reaction has been observed in some patients while on the quinolone class of drugs.

Adverse Reactions: At least 5% experienced: Nausea

Adverse Reactions: Less than 5% experienced: Diarrhea, vomiting, abdominal pain/discomfort, headache, restlessness, rash, palpitation, atrial flutter, ventricular ectopy, syncope, hypertension, angina pectoris, myocardial infarction, cardiopulmonary arrest, cerebral thromobosis, dizziness, lightheadedness, insomnia, nightmares, hallucinations, manic reaction, irritability, tremor, ataxia, convulsive seizures, lethargy, drowsiness, weakness, malaise, anorexia, phobia, depersonalization, depression, paresthesia, painful oral mucous, oral candidiasis, dysphagia, intestinal perforation, gastrointestinal bleeding, cholestatic jaundice, arthralgia or back pain, joint stiffness, achiness, neck or chest pain, flare up of gout, interstitial nephritis, nephritis, renal failure, polyuria, urinary retention, urethral bleeding, vaginitis, acidosis, dyspnea, epistaxis, laryngeal or pulmonary edema, hiccough, memophysis, bronchospase, pumonary embolism, pruritus, urticaria, photosensitivity, flushing, fever, chills, angioedema, edema of the face, neck, lips, conjuctivae or hands, cutaneous candidiasis, hyperpigmentation, erythera nodosum, blurred vision, disturbed vision, decreased visual acuity, diplopia, eye pain, tinnitus, hearing loss, bad taste, vaginitis, headache, vaginal pruritus, abdominal discomfort, lymphadenopathy, foot pain, dizziness, breast pain, nausea, diarrhea, central nervous system disturbance, abnormalities of liver associated enzymes, eosinophila, restlessness, rash, cardiovascular collapse, cardiopulmonary arrest, myocardial infarction, arrhythmia, tachycardia, palpitation, cerebral thrombosis, syncope, cardiac murmur, hypertension, hypotension, angina pectoris, convulsive seizures, paranoia, toxic psychosis, depression, dysphasia, phobia, depersonalization, manic reaction, unresponsiveness, ataxia, confusion, hallucinations, dizziness, lightheadedness, paresthesia, anxiety, tremor, insomnia, nightmares, weakness, drowsiness, irritability, malaise, lethargy, ileus, jaundice, gastrointestinal bleeding, C. difficle associated diarrhea, pseudomembranous colitis, pancreatitis, hepatic necrosis, intestinal perforation, dyspepsia, epigastric or abdominal pain, vomiting, constipation, oral ulceration, oral candidiasis, mouth dryness, anorexia, dysphagia, flatulence, thrombophlebitis, burning, pain, pruritus, paresthesia, erythema, swelling, arthralgia, jaw, arm or back pain, joint stiffness, neck and chest pain, achiness, flare up of gout, renal failure, intarstitial nephritis, hemorrhagic cystitis, renal calcuti, frequent urination, acidosis, urethral bleeding, polyuria, urinary retention, gynecomastia, candiduria, vaginitis. Crystalluria, cylindruria, hematuria, and albuminuria have also been reported, respiratory arrest, pulmonary embolism, dyspnea, pulmonary edema, respiratory distress, pleural effusion, hemoptysis, epistaxis, hiccough, anaphylactic reactions, erythema multiforme/Stevens-Johnson syndrome, exfoliative dermatitis, toxic epidermal necrolysis, vasculitis, angioedema, edema of the lips, face, neck, conjunctivae, hands or lower extremities, purpura, fever, chills, flushing, pruritus, urtigaria, cutaneous candidiasis, vesicles, increased perspiration, hyperpigmentation, erythema nodosum, photosensitivity. Allergic reactions ranging from urticaria to anaphylactic reactions have been reported. Also experienced were decreased visual acuity, blurred vision, disturbed vision (flashing lights, change in color perception, overbrightness of lights, diplopia), eye pain, anosmia, hearing loss, tinnitus, nystagmus, a bad taste, agranulocytosis, prolongation of prothrombin time, and possible exacerbation of myasthenia gravis, change in serum phenytoin, postural hypotension, vasculitis, agitation, confusion, delirium, dysphasia, myoclonus, nystagmus, toxic psychosis, constipation, dyspepsia, flatulence, hepatic necrosis, jaundice, pancreatitis, pseudomembranous colitis. (The onset of pseudomembranous colitis symptoms may occur during or after antimicrobial treatment.), agranulocytosis, hemolytic anemia, methemaglobinemia, prolongation of prothrombin time, elevation of serum triglycerides, cholesterol, blood glucose, serum potassium, myalgia, possible exacerbation of myasthenia gravis, tendinitis/tendon rupture, albuminuria, candiduria, renal calculi, vaginal candidiasis, anaphylactic reactions, erythema multiforme/Stevens-Johnson syndrome, exfoliative dermatitis, toxic epidermal necrolysis, anosmia, taste loss.

Post-Marketing Adverse Events: The following adverse events have been reported from worldwide marketing experience with quinolones, including ciprofloxacin. Because these events are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Decisions to include these events in labeling are typically based on one or more of the following factors: (1) seriousness of the event, (2) frequency of the reporting, or (3) strength of causal connection to the drug. Agitation, agranulocytosis, albuminuria, anaphylactic reactions, anosmia, candiduria, cholesterol elevation (serum), confusion, constipation, delirium, dyspepsia, dysphagia, erythema multiforme, exfoliative dermatitis, fixed eruption,  flatulence, glucose elevation (blood), hemolytic anemia, hepatic failure, hepatic necrosis, hyperesthesia, hypertonia, hypesthesia, hypotension (postural), jaundice, marrow depression (life threatening), methemoglobinemia, monoliasis moniliasis (oral, gastrointestinal, vaginal), myalgia, myasthenia, myasthenia gravis (possible exacerbation), myoclonus, nystagmus, pancreatitis, pancytopenia (life threatening or fatal outcome), peripheral neuropathy, phenytoin alteration (serum), potassium elevation (serum), prothrombin time prolongation or decrease, pseudomembranous colitis (The onset of pseudomembranous colitis symptoms may occur during or after antimicrobial treatment.), psychosis (toxic), renal calculi, serum sickness like reaction, Stevens-Johnson syndrome, taste loss, tendonitis, tendon rupture, torsades de pointes, toxic epidermal necrolysis, triglyceride elevation (serum), twitching, vaginal candidiasis, and vasculitis.

Are there many antibiotics with this list of proven, officially admitted serious toxic side effects? No, there are not. Are there many antibiotics that are forbidden for persons under age 18? No, there are not. Is there any antibiotic with the capacity to rupture tendons? No, there is not. Is there any class of antibiotics with so many of its derivatives withdrawn from the market? No, there is not. Except for quinolones. So it is difficult to understand the “history of harmlessness” of fluoroquinolones.

32. SOCIAL QUINO-EXPERIMENTATION

You have the opportunity to conduct your own social research about the impact of the fluoroquinolones. In a few months time you can complete an experiment that all top (useless) researchers have failed to do with all of their paraphernalia and supposedly scientific methodologies. We have done it.

First part of the experiment. For several months ask the people you know about the final events before the passing of their elderly loved ones. You will find interesting situations. Examples of real ones:

      An old woman that lives entirely on her own in good health. She gets a chest infection and is prescribed an antibiotic. In two days she lost her mind, she did not even recognize her own sons and daughters. Soon she is unable to stand up with a lot of pains and is put in bed. She dies 10 days later of "generalized stroke". Cipro was the antibiotic prescribed during the 10 days.

      An old neighbor in good health and very active. Not on any medications. He gets a urinary infection (burning during urination) and is prescribed cipro. In three days he dies pacefully. Official cause of death--a heart arrythmia with stroke.

      Middle-aged man, co-worker. His appendix is surgically removed. Profilactic cipro is administered. Kidney failure and death.

      Middle-aged woman. She has a first stage pancreatic cancer. During surgery levaquin is administered. Her pancreas and liver enzymes skyrocket and the doctors switch to another antibiotic. Too late. She dies of liver and kidney insufficiency.

      Middle-aged man. Carpenter. His wife says that he has to leave his job because he has developed a very debilitating tendinitis that already lasts for more than 9 months and is unrelenting. When questioned, the man confirmed he had taken levaquin for the first time in his life, 9 months before, for a sinus infection.

      Brother-in-law comes complaining of numbness in toes, and throbbing pain along the shins. Nothing has changed in his life, and nothing explains this recurrent symptoms. Asked about the drugs he has taken lately he reports none, "well, except an antibiotic that I take a few times per year for oral herpes". The antibiotic was cipro. After sifting to another antibiotic his long-term symptoms have disappeared in 8 months time.

      A veterinarian prescribed a quinolone to the dog of a floxed person (enrofloxacin). Instead of giving him the prescribed quinolone, the floxed person administered the pet levaquin for humans. The floxed person was crippled by a dose of 11 mg per day per kilogram of body weight. He gave the dog 15 mg per day per kilogram of body weight for two weeks. Now, as he puts it, both are floxed. The dog that used to be very active, alive, running the whole day and hyperactive now spends its days just lying in its favorite places and refuses to move. There are innumerable reports of injuries caused by enrofloxacin to all sort of pets and animals, like horses, cats, dogs, etc.

And then ask your co-workers and friends about the antibiotics that they took, and how they fared. You will learn a lot, for sure.

Our social quino-experimentation has lead us to the firm conclusion that to administer fluoroquinolones to old people equals putting them at a very high risk, an unacceptable risk, of not regaining their health ever again, and even of putting them on the verge of dying, depending on many particular factors. If quinolones are not to be used for people under 18, and many doctors start to warn about administering them to older persons, then how can we believe that they are safe medications in general?

We are not saying or insinuating that fluoroquinolones are behind each death or adverse or fatal outcome of a surgery or an illness. But it is interesting to note how many times fluoroquinolones are just there, and sometimes they are the only drugs there, when a person's health deteriorates so rapidly that compromises his/her life. The point we want to raise is that we have never heard of any suspicion or investigation about it. As you will see later in this report, in many medical cases that end in the death of the patient, the quinolone is never scrutinized for its toxicity, when in some cases it seems to be a crucial factor in the fatal outcome. This is specially true in America, where doctors are extremely reluctant to raise issues that are uncomfortable for the industry.