In many states, naturopathic physicians are permitted to prescribe from an extensive formulary. This often includes antibiotics. Though not a traditional approach, sometimes naturopaths feels that prescribing an antibiotic may be appropriate in certain situations. Some of the naturopathic school clinics serve as primary care homes, where patients expect the option of antibiotics. When antibiotics are used, it is crucial that the right ones are being used, and current guidelines are adhered to.
Fluoroquinolone Warnings and Guidelines
It has recently come to light that many physicians, naturopaths included, are slow to adopt 2016 changes in Fluoroquinolone warnings and guidelines laid down by the FDA. Fluoroquinolones, including the extremely popular broad-spectrum antibiotic, ciprofloxacin, are no longer considered first-line treatment for acute sinusitis, bronchitis, or uncomplicated urinary tract infection. Patients, who have these conditions, should be treated with other agents. Fluoroquinolones should only be used as a last resort according to the FDA.
Correlation Between Fluoroquinolone Use and Tendon Rupture
These changes in drug popularity come from extensive research showing a direct correlation between fluoroquinolone use and tendon rupture and other collagen-related reactions.1 Other disabling effects include muscle pain, weakness, tendonitis, peripheral neuropathy and central nervous system effects. According to the FDA, such reactions can last on average 14 months after treatment has been discontinued. These precautions have been added to warning labels on such medications and should be taken seriously by providers. Furthermore, the FDA strongly advised avoiding fluoroquinolones in patients who have ever had a reaction in the past.
Stop Using Fluoroquinolones as First-line Agents
In addition, fluoroquinolones are no longer advocated for treatment for gonorrhea due to widespread resistance.2 Clostridium difficile infection is also associated with fluoroquinolones more than other antibiotics and acknowledged as further support to discontinue their routine use.3 Bottom Line: Stop using Fluoroquinolones as first-line agents (if you must use an antibiotic at all).
Sources:
- Daneman N, Lu H, Redelmeier DA. Fluoroquinolones and collagen associated severe adverse events: a longitudinal cohort study. BMJ Open. 2015;5(11):e010077.
- Kim M, Lloyd A, Condren M, Miller MJ. Beyond antibiotic selection: concordance with the IDSA guidelines for uncomplicated urinary tract infections. Infection. 2015;43:89-94.
- Douros A, Grabowski K, Stahlmann R. Safety issues and drug-drug interactions with commonly used quinolones. Expert Opin Drug Metab Toxicol. 2015;11:25-39.
Node Smith, associate editor for NDNR, is a fifth year naturopathic medical student at NUNM, where he has been instrumental in maintaining a firm connection to the philosophy and heritage of naturopathic medicine amongst the next generation of docs. He helped found the first multi-generational experiential retreat, which brings elders, alumni, and students together for a weekend campout where naturopathic medicine and medical philosophy are experienced in nature. Three years ago he helped found the non-profit, Association for Naturopathic ReVitalization (ANR), for which he serves as the board chairman. ANR has a mission to inspire health practitioners to embody the naturopathic principles through experiential education. Node also has a firm belief that the next era of naturopathic medicine will see a resurgence of in-patient facilities which use fasting, earthing, hydrotherapy and homeopathy to bring people back from chronic diseases of modern living; he is involved in numerous conversations and projects to bring about this vision.
