A previously healthy unmedicated 27-years-old woman had taken Ciproxin (ciprofloxacin) 500 mg twice

Fråga: A previously healthy unmedicated 27-years-old woman had taken Ciproxin (ciprofloxacin) 500 mg twice daily for a urinary tract infection. After three doses loss of touch sensation on the skin of the buttocks and the lateral of aspect on the thighs appeared. It spread peripherally and also appeared on the arms, the back and also on the face. Apart from this change in sensation the patient is well.

Is paraesthesia a known side effect of ciprofloxacin? If so is there a known mechanism of action and a known prognosis?

Sammanfattning: Peripheral neurological side effects which are reversible are known for the group of fluoroquinolones among which ciprofloxacin is one. Cross reactivity may occurr.

Svar: In a previous question to the Drug Information Centre concerning another neurological side effect, 58 cases of paraesthesia are cited from the WHO register of side effect of ciprofloxacin (1). In the Swedish Side Effect Register two cases of paraesthesia and three cases of polyneuropati have been reported which have been considered possible or probable (2). For the related compound norfloxacin larger number of paraesthesias have been reported to the Swedish Side Effect Register (3). In all cases described the outcome has been either descibed as explicity reversible or this information has been missing. In a case report to the Lancet (4) a case of peripheral neuropathy originally precipitated by pefloxacin was aggravated when ciprofloxacin was used for a prolonged period of time. In that case ofloxacin given in the period between pefloxacin and ciprofloxacin treatment also aggravated the neuropathy. On the basis of that case it may be suspected that cross-reactivity between the members of the fluoroquinolone group may appear with respect to peripheral neurological side effects.

The reported cases cited above have appeared at variable intervals from the start of the treatment ranging from a few days to several months. The mechanism of this effect of fluoroquinolones is unknown.

The present case should be reported to the regional side effect register in Stockholm. 1 Drugline nr 09391 (year l993)
2 SWEDIS
3 Drugline nr 08498 (year 1992)

4 Aoun M, Jacqoy C, Debussher L, Bron D, Lehert M, Noel P, Van der Auwera P: Peripheral neuropathy associated with fluoroquinolones. Lancet 1992; 340: 127