Do You Know What 'Floxing' Is? Could It Be Deadly To Your Patients?

(From Rachel Uda, Katie Couric Media)  Floxing is an adverse reaction to a class of commonly prescribed antibiotics called fluoroquinolones.  It’s not common, but fluoroquinolones have been connected to a bewildering array of serious health issues — from peripheral neuropathy to aortic rupture. The Food and Drug Administration has issued a series of advisories about the risks these antibiotics pose and recommended that they only be used to treat certain stubborn infections. But surveys show that plenty of patients are still taking them for issues like pneumonia or urinary tract infections.  Here’s what you need to know about the drugs and the warning signs you should be on the lookout for.

What are fluoroquinolones?

Fluoroquinolones were developed in the 60s and became immensely popular, says Valerie Vaughn, M.D., the director of hospital medicine research at the University of Utah where she studies antibiotic use. They were affordable and convenient because they could be taken as a pill instead of through an I.V. Plus, they’re broad-spectrum, meaning they’re so powerful they indiscriminately kill off both the bad bacteria that may be making a patient sick, along with the good.

“So if you didn’t know exactly what a patient had, you could prescribe a fluoroquinolone,” Dr. Vaughn says. “It was kind of an easy, default choice.”

However, killing off those good germs can knock your gut microbiome out of whack and cause digestive issues like diarrhea. And it can leave you more vulnerable to dangerous bacteria, like Clostridium difficile, which can trigger a large intestine infection. “If you kill enough of the good bacteria in the body, the ones that survived can take over and rage out of control,” Dr. Vaughn says.

But if you’ve ever taken most types of antibiotics, you’re likely already familiar with these unpleasant side effects. What sets fluoroquinolones apart are the odd, and often serious, reactions some patients have reported.

What is floxing?

The hazards these medications pose are slowly being uncovered. In 2008, after pressure from a watchdog group and the Illinois Attorney General’s office, the FDA added its first “black box” warning to fluoroquinolone labels, advising users that the drug has been linked to tendinitis and tendon rupture. Researchers believe the antibiotics may dampen the production of collagen, weakening tendons. The Achilles, the body’s largest tendon, is typically the one that tears.

Then in 2013, the agency issued another alert, this time about the potential for “irreversible peripheral neuropathy,” or damage to the complex web of nerves outside the brain or spinal cord. The condition can cause muscle weakness, a lack of sensation or the feeling of pins and needles pricking your skin, digestive issues, unbearable pain, and more. Five years later, they warned it could trigger blood-sugar fluctuations, and in some cases diabetic coma. In case that wasn’t enough to scare you away, the drugs also raise the risk of tearing the aorta, the massive artery that pumps blood from the heart to the rest of the body.

Granted, most of these issues are rare, but those who’ve been “floxed,” say they can be life-changing.

According to Singer Bobby Caldwell’s family, both the singer’s Achilles ruptured within days of taking the drugs in 2017. He continued to perform with the help of a cane, but the pain from his peripheral neuropathy ultimately forced him to quit.

“Bobby had always planned on performing and making music for the rest of his life,” his family wrote in a statement to fans after the singer abruptly canceled his remaining 2021 concerts. “He never could have anticipated what happened to him.”

Hailey Siebert, 31, tells us she was given levofloxacin two years ago after a dental surgery. Within a couple of days, her Achilles started feeling tender, and she developed a tremor in her back and excruciating pain whether she was sitting, standing, or lying down. Today, she uses a cane to help her walk and, at times, a motor scooter.

“I used to weight lift and snowboard,” Siebert says. “My life looks nothing like it did before I took this antibiotic.”

She’s now working with a rheumatologist to manage her symptoms, but it took her months to even find a doctor who would take her concerns seriously. “I was just being gaslit and told this isn’t possible,” Siebert says. She began posting on TikTok and even created a website, What the Flox, to connect with others who’ve been “cycled through the healthcare system” and to generate more awareness around these antibiotics.

“There just seems to be a disconnect between the patient and their medical providers,” she says. “And I just hope that changes.”

The future of fluoroquinolones

There’s a long list of patients the FDA says should steer clear of the drugs (unless no other option is available), including seniors, people with high blood pressure, or anyone who’s had an aneurysm or blood vessel blockages. But in some cases, they’re still essential, says Barbara Trautner, M.D., Ph.D., a clinician at the Houston V.A. Medical Center studying antibiotics. They’re often used for pneumonia or persistent bone or joint infections. But medical experts have really begun scrutinizing these drugs and have drastically cut back on prescribing them. Over the past decade, the V.A. hospital system has cut their fluoroquinolone use by half, Dr. Vaughn says. Other big, well-funded programs are doing the same, but some rural hospitals and over-taxed urgent care clinics are lagging, she says.

There’s another wrinkle too. Dr. Vaughn’s research shows that although many facilities are doing their best to avoid the drugs while a patient is being treated there, some are still being given a fluoroquinolone after they’ve been discharged. Hospitals often have strict rules around antibiotics and when to deploy them, but they don’t always extend to discharge prescriptions. “It’s a big loophole,” she says.

Dr. Trautner believes that when it comes to all antibiotics, a mind shift within medicine needs to take place. As medical professionals, she says, their instinct is to prescribe and attack an infection head-on, when sometimes a patient may be better off without one. Because of this decades-long attachment, these drugs are becoming less effective — a phenomenon known as antibiotic resistance. Germs and bacteria are developing the ability to defeat the very drugs designed to knock them out, and superbugs, which can’t be killed off with our current arsenal of medications, are rising.

Scientists have also learned that the conventional wisdom about finishing your course of antibiotics is wrong, Dr. Vaughn says. There are some exceptions, but for most common infections, you can actually stop taking them once you’re feeling better, she says. Studies have shown that in treating pneumonia, for example, taking the drugs for five days worked just as well at clearing the infection as a 10-day course.

“But people are still saying this and it’s hard to change something that’s been held up for 30 or 40 years,” she tells us.

“We as a society use antibiotics very regularly and probably more often than we should, for longer courses than we should take them,” Dr. Trautner says. “No one is doing this to be malicious. Antibiotics have this great public reputation, but potentially you’re doing yourself harm.”

Please read more at What Does Floxed Mean from Katie Couric Media.