Clinical toxicological aspects of fluoroquinolones.

Reactions of the gastrointestinal tract and the central nervous system are the most often observed adverse effects during therapy with fluoroquinolones. Pathogenesis of the neurotoxic effects of fluoroquinolones could be related to the activation of the NMDA receptor. Animal experiments as well as clinical experience show that the cardiotoxic potentials of sparfloxacin and grepafloxacin are higher than those of the other fluoroquinolones: they cause QT prolongation at rather low doses thus increasing the risk for severe arrhythmia (torsades de pointes). Phototoxicity has been described for all quinolones, but derivatives with a halogen atom at position 8 show the highest potential for such reactions (e.g. clinafloxacin). Chondrotoxicity of quinolones can affect the articular cartilage and the epiphyseal growth plate in immature animals; the use of these drugs in pediatrics should be restricted to carefully selected indications (such as the use of ciprofloxacin in cystic fibrosis). Tendinitis and tendon ruptures can also be induced by quinolones. Overall, quinolones are as well tolerated as most other anti-microbial agents. However, their specific toxic potentials have to be considered when they are chosen for treatment of bacterial infections.