CC BY-NC-ND 4.0 · Ibnosina Journal of Medicine and Biomedical Sciences 2024; 16(02): 029-037
DOI: 10.1055/s-0043-1777825
Review Article

Overview of Tendinopathy, Peripheral Neuropathy, Aortic Aneurysm, and Hypoglycemia Caused by Fluoroquinolones

1   Department of Pharmacology, J.K.K. Nattraja College of Pharmacy, Komarapalayam, Tamil Nadu, India
,
Naina Mohamed Pakkir Maideen
2   Pharmacy, Dubai Health Authority, Dubai, United Arab Emirates
,
Harikrishnan Narayanaswamy
3   Faculty of Pharmacy, Dr. M.G.R. Educational and Research Institute (Deemed to be University), A.C.S. Medical College and Hospital Campus, Velappanchavadi, Chennai, Tamil Nadu, India
› Author Affiliations
Funding and Sponsorship No author received funds for the preparation of this manuscript.

Abstract

Background Fluoroquinolones (FQs) are widely used in the management of several bacterial infections including urinary tract infections (UTIs), upper respiratory tract infections (URTIs), lower respiratory tract infections (LRTIs), skin and soft tissue, gastrointestinal tract infections (GITIs), and many other infections.

Objective This review article focuses on some serious side effects notified by United States Food and Drug Administration (US FDA) in different warning statements.

Methods The literature was searched, in databases such as Medline/PubMed/PMC, Google Scholar, Science Direct, Ebsco, Scopus, Web of science, Embase, and reference lists to identify publications relevant to the serious side effects associated with the use of FQs.

Results Several epidemiological studies and meta-analyses have documented the occurrence of serious side effects of FQs including tendinopathy, peripheral neuropathy, aortic aneurysm/dissection, hypoglycemia, QT prolongation, retinal detachment, and worsening of myasthenia gravis.

Conclusion The clinicians should be aware of serious side effects of FQs. The US FDA and European Medicines Agency recommend against the use of FQs as first-line therapies to treat infections such as acute sinusitis, acute bronchitis, and uncomplicated UTIs, as the risks outweigh the benefits. The risk of incidence of serious side effects of FQs is higher among patients with advanced age, renal insufficiency, and certain concomitant medications. To avoid occurrence of any serious side effects of FQs, the clinicians should prefer non-FQ antibacterial drugs to manage uncomplicated UTIs, respiratory tract infections, and other infections for which alternatives available.

Authors' Contributions

R.B. contributed substantially to conception and design and acquisition of data; N.M.P.M. helped in conception and design, data analysis, and interpretation of data; H.N. drafted the article and revised it critically for important contents.


Compliance with Ethical Principles

No ethical approval is required for review articles.




Publication History

Article published online:
27 March 2024

© 2024. The Libyan Biotechnology Research Center. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Majalekar PP, Shirote PJ. Fluoroquinolones: blessings or curses. Curr Drug Targets 2020; 21 (13) 1354-1370
  • 2 Ezelarab HAA, Abbas SH, Hassan HA, Abuo-Rahma GEA. Recent updates of fluoroquinolones as antibacterial agents. Arch Pharm (Weinheim) 2018; 351 (09) e1800141
  • 3 Mimouni FZ, Belboukhari N, Sekkoum K. Mini review: is fluoroquinolone drug or poison?. J Complexity in Health Sci 2019; 2 (02) 70-76
  • 4 Fedorowicz J, Sączewski J. Modifications of quinolones and fluoroquinolones: hybrid compounds and dual-action molecules. Monatsh Chem 2018; 149 (07) 1199-1245
  • 5 Baggio D, Ananda-Rajah MR. Fluoroquinolone antibiotics and adverse events. Aust Prescr 2021; 44 (05) 161-164
  • 6 US Food and Drug Administration. FDA Drug Safety Communication: FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects. December 20, 2018. Accessed December 7, 2023 at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-updates-warnings-oral-and-injectable-fluoroquinolone-antibiotics
  • 7 European Medicines Agency. Disabling and potentially permanent side effects lead to suspension or restrictions of quinolone and fluoroquinolone antibiotics. November 16, 2018. Accessed December 7, 2023 at: https://www.ema.europa.eu/en/news/disabling-potentially-permanent-side-effects-lead-suspension-restrictions-quinolone-fluoroquinolone
  • 8 Mathews B, Thalody AA, Miraj SS, Kunhikatta V, Rao M, Saravu K. Adverse effects of fluoroquinolones: a retrospective cohort study in a South Indian tertiary healthcare facility. Antibiotics (Basel) 2019; 8 (03) 104
  • 9 Bailey RR, Kirk JA, Peddie BA. Norfloxacin-induced rheumatic disease. N Z Med J 1983; 96 (736) 590
  • 10 McEwan SR, Davey PG. Ciprofloxacin and tenosynovitis. Lancet 1988; 2 (8616): 900
  • 11 Khaliq Y, Zhanel GG. Fluoroquinolone-associated tendinopathy: a critical review of the literature. Clin Infect Dis 2003; 36 (11) 1404-1410
  • 12 Arabyat RM, Raisch DW, McKoy JM, Bennett CL. Fluoroquinolone-associated tendon-rupture: a summary of reports in the Food and Drug Administration's adverse event reporting system. Expert Opin Drug Saf 2015; 14 (11) 1653-1660
  • 13 Berger I, Goodwin I, Buncke GM. Fluoroquinolone-associated tendinopathy of the hand and wrist: a systematic review and case report. Hand (N Y) 2017; 12 (05) NP121-NP126
  • 14 Godoy-Santos AL, Bruschini H, Cury J. et al. Fluoroquinolones and the risk of Achilles tendon disorders: update on a neglected complication. Urology 2018; 113: 20-25
  • 15 Stephenson AL, Wu W, Cortes D, Rochon PA. Tendon injury and fluoroquinolone use: a systematic review. Drug Saf 2013; 36 (09) 709-721
  • 16 Alves C, Mendes D, Marques FB. Fluoroquinolones and the risk of tendon injury: a systematic review and meta-analysis. Eur J Clin Pharmacol 2019; 75 (10) 1431-1443
  • 17 Lewis T, Cook J. Fluoroquinolones and tendinopathy: a guide for athletes and sports clinicians and a systematic review of the literature. J Athl Train 2014; 49 (03) 422-427
  • 18 Bisaccia DR, Aicale R, Tarantino D, Peretti GM, Maffulli N. Biological and chemical changes in fluoroquinolone-associated tendinopathies: a systematic review. Br Med Bull 2019; 130 (01) 39-49
  • 19 Tanne JH. FDA adds “black box” warning label to fluoroquinolone antibiotics. BMJ 2008; 337 (7662): a816
  • 20 Francis JK, Higgins E. Permanent peripheral neuropathy: a case report on a rare but serious debilitating side-effect of fluoroquinolone administration. J Investig Med High Impact Case Rep 2014; 2 (03) 2324709614545225
  • 21 Estofan LJF, Naydin S, Gliebus G. Quinolone-induced painful peripheral neuropathy: a case report and literature review. J Investig Med High Impact Case Rep 2018; 6: 2324709617752736
  • 22 Morley C, Carvalho de Almeida C, Moloney S, Grimwood K. Ciprofloxacin-associated peripheral neuropathy in a child: a case report and review of the literature. Pediatr Infect Dis J 2022; 41 (02) 121-122
  • 23 Etminan M, Brophy JM, Samii A. Oral fluoroquinolone use and risk of peripheral neuropathy: a pharmacoepidemiologic study. Neurology 2014; 83 (14) 1261-1263
  • 24 Morales D, Pacurariu A, Slattery J, Pinheiro L, McGettigan P, Kurz X. Association between peripheral neuropathy and exposure to oral fluoroquinolone or amoxicillin-clavulanate therapy. JAMA Neurol 2019; 76 (07) 827-833
  • 25 Ali AK. Peripheral neuropathy and Guillain-Barré syndrome risks associated with exposure to systemic fluoroquinolones: a pharmacovigilance analysis. Ann Epidemiol 2014; 24 (04) 279-285
  • 26 Huruba M, Farcas A, Leucuta DC, Bucsa C, Mogosan C. A VigiBase descriptive study of fluoroquinolone-associated peripheral nervous system disorders. Pharmaceuticals (Basel) 2022; 15 (02) 143
  • 27 US Food and Drug Administration. FDA Drug Safety Communication: FDA requires label changes to warn of risk for possibly permanent nerve damage from antibacterial fluoroquinolone drugs taken by mouth or by injection. August 15, 2013. Accessed December 7, 2023 at: http://www.fda.gov/Drugs/DrugSafety/ucm365050.htm
  • 28 Daneman N, Lu H, Redelmeier DA. Fluoroquinolones and collagen associated severe adverse events: a longitudinal cohort study. BMJ Open 2015; 5 (11) e010077
  • 29 Lee CC, Lee MT, Chen YS. et al. Risk of aortic dissection and aortic aneurysm in patients taking oral fluoroquinolone. JAMA Intern Med 2015; 175 (11) 1839-1847
  • 30 Pasternak B, Inghammar M, Svanström H. Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study. BMJ 2018; 360: k678
  • 31 Lee CC, Lee MG, Hsieh R. et al. Oral fluoroquinolone and the risk of aortic dissection. J Am Coll Cardiol 2018; 72 (12) 1369-1378
  • 32 Meng L, Huang J, Jia Y, Huang H, Qiu F, Sun S. Assessing fluoroquinolone-associated aortic aneurysm and dissection: data mining of the public version of the FDA adverse event reporting system. Int J Clin Pract 2019; 73 (05) e13331
  • 33 Noman AT, Qazi AH, Alqasrawi M. et al. Fluoroquinolones and the risk of aortopathy: a systematic review and meta-analysis. Int J Cardiol 2019; 274: 299-302
  • 34 Latif A, Ahsan MJ, Malik SU. et al. Fluoroquinolones and the Risk of Aortopathy: a systematic review and meta-Analysis. Circulation 2019; 140: A15936
  • 35 Dai XC, Yang XX, Ma L, Tang GM, Pan YY, Hu HL. Relationship between fluoroquinolones and the risk of aortic diseases: a meta-analysis of observational studies. BMC Cardiovasc Disord 2020; 20 (01) 49
  • 36 Lai CC, Wang YH, Chen KH, Chen CH, Wang CY. The association between the risk of aortic aneurysm/aortic dissection and the use of fluroquinolones: a systematic review and meta-analysis. Antibiotics (Basel) 2021; 10 (06) 697
  • 37 Vouga Ribeiro N, Gouveia Melo R, Guerra NC. et al. Fluoroquinolones are associated with increased risk of aortic aneurysm or dissection: systematic review and meta-analysis. Semin Thorac Cardiovasc Surg 2021; 33 (04) 907-918
  • 38 Chen C, Patterson B, Simpson R. et al. Do fluoroquinolones increase aortic aneurysm or dissection incidence and mortality? A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9: 949538
  • 39 Chen SW, Chan YH, Chien-Chia Wu V. et al. Effects of fluoroquinolones on outcomes of patients with aortic dissection or aneurysm. J Am Coll Cardiol 2021; 77 (15) 1875-1887
  • 40 Chen YY, Yang SF, Yeh HW. et al. Association between aortic aneurysm and aortic dissection with fluoroquinolones use in patients with urinary tract infections: a population-based cohort study. J Am Heart Assoc 2022; 11 (06) e023267
  • 41 Son N, Choi E, Chung SY, Han SY, Kim B. Risk of aortic aneurysm and aortic dissection with the use of fluoroquinolones in Korea: a nested case-control study. BMC Cardiovasc Disord 2022; 22 (01) 44
  • 42 Leonova MV. Collagen-associated side effects of fluoroquinolones: aneurysm and aortic dissection (systematic review). Consilium Medicum. 2022; 24 (01) 66-70
  • 43 Guzzardi DG, Teng G, Kang S. et al. Induction of human aortic myofibroblast-mediated extracellular matrix dysregulation: a potential mechanism of fluoroquinolone-associated aortopathy. J Thorac Cardiovasc Surg 2019; 157 (01) 109-119.e2
  • 44 Rawla P, El Helou ML, Vellipuram AR. Fluoroquinolones and the risk of aortic aneurysm or aortic dissection: a systematic review and meta-analysis. Cardiovasc Hematol Agents Med Chem 2019; 17 (01) 3-10
  • 45 Wee I, Chin B, Syn N, Lee KS, Ng JJ, Choong AMTL. The association between fluoroquinolones and aortic dissection and aortic aneurysms: a systematic review and meta-analysis. Sci Rep 2021; 11 (01) 11073
  • 46 Jun C, Fang B. Current progress of fluoroquinolones-increased risk of aortic aneurysm and dissection. BMC Cardiovasc Disord 2021; 21 (01) 470
  • 47 Zhang J, Zhang Z. Fluoroquinolones increase the risk of aortic aneurysm and dissection: a protocol for meta-analysis. Medicine (Baltimore) 2021; 100 (51) e28081
  • 48 US Food and Drug Administration. FDA Drug Safety Communication: FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients. December 20, 2018. Accessed December 7, 2023 at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-increased-risk-ruptures-or-tears-aorta-blood-vessel-fluoroquinolone-antibiotics
  • 49 Etminan M, Forooghian F, Brophy JM, Bird ST, Maberley D. Oral fluoroquinolones and the risk of retinal detachment. JAMA 2012; 307 (13) 1414-1419
  • 50 Kuo SC, Chen YT, Lee YT. et al. Association between recent use of fluoroquinolones and rhegmatogenous retinal detachment: a population-based cohort study. Clin Infect Dis 2014; 58 (02) 197-203
  • 51 Raguideau F, Lemaitre M, Dray-Spira R, Zureik M. Association between oral fluoroquinolone use and retinal detachment. JAMA Ophthalmol 2016; 134 (04) 415-421
  • 52 Baek YH, Park SJ, Jeong S. et al. Signal detection between fluoroquinolone use and the risk of rhegmatogenous retinal detachment: sequence symmetry analysis using nationwide South Korean healthcare database between 2004 and 2015. Clin Drug Investig 2018; 38 (12) 1179-1188
  • 53 Taher MK, Alami A, Gravel CA. et al. Systemic quinolones and risk of retinal detachment I: analysis of data from the US FDA adverse event reporting system. Expert Opin Drug Saf 2022; 21 (02) 269-276
  • 54 Pasternak B, Svanström H, Melbye M, Hviid A. Association between oral fluoroquinolone use and retinal detachment. JAMA 2013; 310 (20) 2184-2190
  • 55 Fife D, Zhu V, Voss E, Levy-Clarke G, Ryan P. Exposure to oral fluoroquinolones and the risk of retinal detachment: retrospective analyses of two large healthcare databases. Drug Saf 2014; 37 (03) 171-182
  • 56 Kapoor KG, Hodge DO, St Sauver JL, Barkmeier AJ. Oral fluoroquinolones and the incidence of rhegmatogenous retinal detachment and symptomatic retinal breaks: a population-based study. Ophthalmology 2014; 121 (06) 1269-1273
  • 57 Eftekhari K, Ghodasra DH, Haynes K, Chen J, Kempen JH, VanderBeek BL. Risk of retinal tear or detachment with oral fluoroquinolone use: a cohort study. Pharmacoepidemiol Drug Saf 2014; 23 (07) 745-752
  • 58 Chui CS, Man KK, Cheng CL. et al. An investigation of the potential association between retinal detachment and oral fluoroquinolones: a self-controlled case series study. J Antimicrob Chemother 2014; 69 (09) 2563-2567
  • 59 Choi SY, Lim HA, Yim HW, Park YH. Administration of oral fluoroquinolone and the risk of rhegmatogenous retinal detachment: a nationwide population-based study in Korea. PLoS One 2018; 13 (04) e0195563
  • 60 Taher MK, Crispo JAG, Fortin Y. et al. Systemic quinolones and risk of retinal detachment III: a nested case-control study using a US electronic health records database. Eur J Clin Pharmacol 2022; 78 (06) 1019-1028
  • 61 Chui CS, Wong IC, Wong LY, Chan EW. Association between oral fluoroquinolone use and the development of retinal detachment: a systematic review and meta-analysis of observational studies. J Antimicrob Chemother 2015; 70 (04) 971-978
  • 62 Alves C, Penedones A, Mendes D, Batel Marques F. A systematic review and meta-analysis of the association between systemic fluoroquinolones and retinal detachment. Acta Ophthalmol 2016; 94 (05) e251-e259
  • 63 Taher MK, Habsah M, Bjerre L, Momoli F, Mattison D, Krewski D. Systemic quinolones and risk of retinal detachment II: systematic review of clinical trials. Clin Med Rev Case Rep 2021; 8: 369
  • 64 Granados J, Ceballos M, Amariles P. [Hypo or hyperglycemia associated with fluoroquinolone use]. Rev Med Chil 2018; 146 (05) 618-626
  • 65 Pakkir Maideen NM. Pharmacokinetic and pharmacodynamic interactions of sulfonylurea antidiabetics. Eur J Med 2018; 6: 83-96
  • 66 Chou HW, Wang JL, Chang CH, Lee JJ, Shau WY, Lai MS. Risk of severe dysglycemia among diabetic patients receiving levofloxacin, ciprofloxacin, or moxifloxacin in Taiwan. Clin Infect Dis 2013; 57 (07) 971-980
  • 67 Aspinall SL, Good CB, Jiang R, McCarren M, Dong D, Cunningham FE. Severe dysglycemia with the fluoroquinolones: a class effect?. Clin Infect Dis 2009; 49 (03) 402-408
  • 68 Saad NA, Elberry AA, Samy Matar H, Hussein RRS. Effect of ciprofloxacin vs levofloxacin on QTc-interval and dysglycemia in diabetic and non-diabetic patients. Int J Clin Pract 2021; 75 (05) e14072
  • 69 Liao SH, Hu SY, How CK. et al. Risk for hypoglycemic emergency with levofloxacin use, a population-based propensity score matched nested case-control study. PLoS One 2022; 17 (04) e0266471
  • 70 Kabbara WK, Ramadan WH, Rahbany P, Al-Natour S. Evaluation of the appropriate use of commonly prescribed fluoroquinolones and the risk of dysglycemia. Ther Clin Risk Manag 2015; 11: 639-647
  • 71 Berhe A, Russom M, Bahran F, Hagos G. Ciprofloxacin and risk of hypoglycemia in non-diabetic patients. J Med Case Rep 2019; 13 (01) 1-6
  • 72 Althaqafi A, Ali M, Alzahrani Y, Ming LC, Hussain Z. How safe are fluoroquinolones for diabetic patients? A systematic review of dysglycemic and neuropathic effects of fluoroquinolones. Ther Clin Risk Manag 2021; 17: 1083-1090
  • 73 El Ghandour S, Azar ST. Dysglycemia associated with quinolones. Prim Care Diabetes 2015; 9 (03) 168-171
  • 74 US Food and Drug Administration. FDA Drug Safety Communication: FDA reinforces safety information about serious low blood sugar levels and mental health side effects with fluoroquinolone antibiotics; requires label; changes. July 10, 2018. Accessed December 7, 2023 at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-reinforces-safety-information-about-serious-low-blood-sugar-levels-and-mental-health-side
  • 75 Falagas ME, Rafailidis PI, Rosmarakis ES. Arrhythmias associated with fluoroquinolone therapy. Int J Antimicrob Agents 2007; 29 (04) 374-379
  • 76 Zambon A, Polo Friz H, Contiero P, Corrao G. Effect of macrolide and fluoroquinolone antibacterials on the risk of ventricular arrhythmia and cardiac arrest: an observational study in Italy using case-control, case-crossover and case-time-control designs. Drug Saf 2009; 32 (02) 159-167
  • 77 Lapi F, Wilchesky M, Kezouh A, Benisty JI, Ernst P, Suissa S. Fluoroquinolones and the risk of serious arrhythmia: a population-based study. Clin Infect Dis 2012; 55 (11) 1457-1465
  • 78 Chou HW, Wang JL, Chang CH, Lai CL, Lai MS, Chan KA. Risks of cardiac arrhythmia and mortality among patients using new-generation macrolides, fluoroquinolones, and β-lactam/β-lactamase inhibitors: a Taiwanese nationwide study. Clin Infect Dis 2015; 60 (04) 566-577
  • 79 Liu X, Ma J, Huang L. et al. Fluoroquinolones increase the risk of serious arrhythmias: a systematic review and meta-analysis. Medicine (Baltimore) 2017; 96 (44) e8273
  • 80 Inghammar M, Svanström H, Melbye M, Pasternak B, Hviid A. Oral fluoroquinolone use and serious arrhythmia: bi-national cohort study. BMJ 2016; 352: i843
  • 81 Gorelik E, Masarwa R, Perlman A. et al. Fluoroquinolones and cardiovascular risk: a systematic review, meta-analysis and network meta-analysis. Drug Saf 2019; 42 (04) 529-538
  • 82 Cho Y, Park HS. Association of oral ciprofloxacin, levofloxacin, ofloxacin and moxifloxacin with the risk of serious ventricular arrhythmia: a nationwide cohort study in Korea. BMJ Open 2018; 8 (09) e020974
  • 83 Assimon MM, Pun PH, Wang LC. et al. Analysis of respiratory fluoroquinolones and the risk of sudden cardiac death among patients receiving hemodialysis. JAMA Cardiol 2022; 7 (01) 75-83
  • 84 Briasoulis A, Agarwal V, Pierce WJ. QT prolongation and torsade de pointes induced by fluoroquinolones: infrequent side effects from commonly used medications. Cardiology 2011; 120 (02) 103-110
  • 85 Wang SH, Xie YC, Jiang B. et al. [Fluoroquinolone associated myasthenia gravis exacerbation: clinical analysis of 9 cases]. Zhonghua Yi Xue Za Zhi 2013; 93 (17) 1283-1286
  • 86 Jones SC, Sorbello A, Boucher RM. Fluoroquinolone-associated myasthenia gravis exacerbation: evaluation of postmarketing reports from the US FDA adverse event reporting system and a literature review. Drug Saf 2011; 34 (10) 839-847
  • 87 Krenn M, Grisold A, Wohlfarth P. et al. Pathomechanisms and clinical implications of myasthenic syndromes exacerbated and induced by medical treatments. Front Mol Neurosci 2020; 13: 156
  • 88 Sheikh S, Alvi U, Soliven B, Rezania K. Drugs that induce or cause deterioration of myasthenia gravis: an update. J Clin Med 2021; 10 (07) 1537
  • 89 US Food and Drug Administration. FDA Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together. May 12, 2016. Accessed December 7, 2023 at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-advises-restricting-fluoroquinolone-antibiotic-use-certain
  • 90 European Medicines Agency. Quinolone- and Fluoroquinolone-Containing Medicinal Products. March 19, 2019. Accessed December 7, 2023 at: https://www.ema.europa.eu/en/medicines/human/referrals/quinolone-fluoroquinolone-containing-medicinal-products
  • 91 Bratsman A, Mathias K, Laubscher R, Grigoryan L, Rose S. Outpatient fluoroquinolone prescribing patterns before and after US FDA boxed warning. Pharmacoepidemiol Drug Saf 2020; 29 (06) 701-707
  • 92 Sankar A, Swanson KM, Zhou J. et al. Association of fluoroquinolone prescribing rates with black box warnings from the US food and drug administration. JAMA Netw Open 2021; 4 (12) e2136662
  • 93 Bonkat G, Wagenlehner F. In the line of fire: should urologists stop prescribing fluoroquinolones as default?. Eur Urol 2019; 75 (02) 205-207
  • 94 Pietruszyński R, Pietruszyńska-Reszetarska A, Sokal J, Domżalski M. Antioxidant therapy in the management of fluoroquinolone-associated disability. Arch Med Sci 2020; 16 (06) 1483-1486
  • 95 Gatti M, Bianchin M, Raschi E, De Ponti F. Assessing the association between fluoroquinolones and emerging adverse drug reactions raised by regulatory agencies: an umbrella review. Eur J Intern Med 2020; 75: 60-70