Fluoroquinolones should be avoided in myasthenia gravis
2004; Elsevier BV; Volume: 44; Issue: 1 Linguagem: Inglês
10.1016/j.annemergmed.2004.01.027
ISSN1097-6760
Autores Tópico(s)Peripheral Neuropathies and Disorders
ResumoTo the Editor: We had just finished intubating our patient with myasthenia gravis (just using etomidate) and were about to order levofloxacin for pneumonia, when the neurology resident rushed up and said, “Wait, whatever you do, don't give her levofloxacin!” A month before, a patient with myasthenia gravis had been admitted to the neurology service for pneumonia and had a protracted myasthenic crisis after the administration of a fluoroquinolone. We were lucky our neurology resident was familiar with the case, because this information had not filtered down to the emergency department. Guidelines for Letters to the EditorAnnals welcomes letters to the editor, including observations, opinions, corrections, very brief reports, and comments on published articles. Letters to the editor will not be accepted if they exceed 500 words and 5 references. They should be submitted using Annals' Web-based peer review system, Editorial Manager™ (http://AnnEmergMed.editorialmanager.com). Annals no longer accepts submissions by mail.Letters should not contain abbreviations. A manuscript submission agreement, signed by all authors, must be faxed to the Annals office at the time of submission. Financial associations or other possible conflicts of interest should always be disclosed. Letters discussing an Annals article must be received within 8 weeks of the article's publication.Published letters will be edited and may be shortened. Unpublished letters will not be returned.Authors of articles for which comments are received will be given the opportunity to reply. If those authors wish to respond, their reply will not be shared with the author of the letter before publication.Neither Annals of Emergency Medicine nor the Publisher accepts responsibility for statements made by contributors or advertisers. Acceptance of an advertisement for placement in Annals in no way represents endorsement of a particular product or service by Annals of Emergency Medicine, the American College of Emergency Physicians, or the Publisher.A literature review quickly identified several case reports of prolonged myasthenic crises after the administration of fluoroquinolones to patients with myasthenia gravis.1.Roquer J. Cano A. Seoane J.L. et al.Myasthenia gravis and ciprofloxacin.Acta Neurol Scand. 1996; 94: 419-420Crossref PubMed Scopus (15) Google Scholar, 2.Vial T. Chauplannaz G. Brunel P. et al.Exacerbation of myasthenia gravis by pefloxacin.Rev Neurol (Paris). 1995; 151: 286-287PubMed Google Scholar, 3.Azevedo E. Ribeiro J.A. Polonia J. et al.Probably exacerbation of myasthenia gravis by ofloxacin.J Neurol. 1993; 240 ([letter]): 508Crossref PubMed Scopus (13) Google Scholar, 4.Mumford C.J. Ginsberg L. Ciprofloxacin and myasthenia gravis.BMJ. 1990; 301: 818Crossref PubMed Scopus (26) Google Scholar In addition, an in vitro study demonstrated that these agents diminish the amplitude of miniature endplate potentials and currents.5.Sieb J.P. Fluoroquinolone antibiotics block neuromuscular transmission.Neurology. 1998; 50: 804-807Crossref PubMed Scopus (37) Google Scholar The Myasthenia Gravis Foundation of American lists fluoroquinolones as one of the categories of drugs to avoid.6.Myasthenia Gravis Foundation of America Web site. Available at: http://www.myasthenia.org/drugs/reference.htm. Accessed April 13, 2004.Google Scholar Annals welcomes letters to the editor, including observations, opinions, corrections, very brief reports, and comments on published articles. Letters to the editor will not be accepted if they exceed 500 words and 5 references. They should be submitted using Annals' Web-based peer review system, Editorial Manager™ (http://AnnEmergMed.editorialmanager.com). Annals no longer accepts submissions by mail. Letters should not contain abbreviations. A manuscript submission agreement, signed by all authors, must be faxed to the Annals office at the time of submission. Financial associations or other possible conflicts of interest should always be disclosed. Letters discussing an Annals article must be received within 8 weeks of the article's publication. Published letters will be edited and may be shortened. Unpublished letters will not be returned. Authors of articles for which comments are received will be given the opportunity to reply. If those authors wish to respond, their reply will not be shared with the author of the letter before publication. Neither Annals of Emergency Medicine nor the Publisher accepts responsibility for statements made by contributors or advertisers. Acceptance of an advertisement for placement in Annals in no way represents endorsement of a particular product or service by Annals of Emergency Medicine, the American College of Emergency Physicians, or the Publisher. Unfortunately, standard sources do not mention this hazard. A review of Lexi-comp, Micromedix, Up-to-Date, Physician's Desk Reference, ePocrates, AHFS Drug Information, and our hospital formulary did not identify this adverse consequence of fluoroquinolones. Thus, on the basis of published case reports and in vitro studies, fluoroquinolones (of any generation) should be avoided in patients with myasthenia gravis. Fluoroquinolones should probably be used with caution in patients with other neuromuscular transmission disorders as well. Safety of succinylcholine in myasthenia gravisAnnals of Emergency MedicineVol. 45Issue 2PreviewTo the Editor: Full-Text PDF
Referência(s)