Dr. Keith Roach
Dear Dr. Roach:I am writing to warn readers of a possible side effect of an antibiotic known as levofloxacin. I was recently treated with this medication for a sinus infection that would not clear up with amoxicillin. After five days of taking the medication, my joints became very inflamed, especially my ankles, and I was in pain. I stopped the medication, but almost three weeks later I still have joint pain.
My doctor never told me about this horrible possible side effect. Levofloxacin is the generic form of Levaquin, which was pulled from the market years ago because of these problems. Why wasn’t the generic form taken off the market as well? The articles state that the symptoms may be permanent. I hope they eventually tone it down because it’s miserable.
KS
Dear KS,Levofloxacin is a powerful drug that should not be used lightly. Janssen Pharmaceuticals discontinued branded Levoquin in 2017; although the company did not specify why, a spokesman said [t]The decision to discontinue Levaquin was made because of the wide availability of alternative treatment options and our focus on developing innovative medicines designed to address the unmet medical needs of patients.
Levofloxacin, like all drugs in the fluoroquinolone class, has the potential to cause serious harm. I think you have tendinopathy (inflammation in the tendons), which is among the more serious side effects, in part because it can cause the tendon to rupture. Although it is reported to be rare (3 per 100,000 cases), I have personally seen more cases than I would expect with these numbers. Most people recover within two months, but some cases have been reported to last for one to two years.
The Food and Drug Administration put a black box warning (the highest possible warning) on levofloxacin to remind doctors of the danger of this side effect and the danger of another symptom called neurological toxicity, which can cause delirium and memory impairment. There are more side effects that occur less frequently.
I almost never prescribe this drug, but I don’t think it should be completely banned. There are some times when this class of medication alone can save lives. But doctors should not prescribe it lightly. I am afraid that too many doctors prescribe antibiotics for viral diseases too often.
Patients want them and sometimes demand them, but we still shouldn’t prescribe them when we know they won’t help. Doctors who refuse antibiotics run the risk of bad reviews from patients, and these can have a significant impact on doctors’ practice. All antibiotics have the potential for adverse effects, and overuse contributes to resistance. But fluoroquinolones, in particular, should be used very sparingly.
Dear Dr. Roach:Tinnitus, which is very loud and makes it difficult to hear people, especially a group of them in a room. Is there anything that can be done for tinnitus? Do hearing aids help? I care more when I’m trying to sleep, but I’m not sure if I could wear hearing aids to bed anyway.
MB
Dear MB,Tinnitus almost always happens with hearing loss, but it’s important to get it tested. For people with hearing loss confirmed by an audiologist, a hearing aid can help understand speech, and can also mask tinnitus, which improves symptoms.
For people who have bothersome symptoms at night, increasing ambient noise can be helpful. My patients have recommended using fans, tuning the radio between stations to provide static at a low volume, and purchasing specialized sound machines. These can be useful for many people, but unfortunately they are not effective for everyone. Occasionally things get worse. The American Tinnitus Association (ATA.org) has many suggestions and references.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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