Nalidixic Acid-Induced Photodermatitis after Minimal Sun Exposure

Barbeau, Gilles; Boisvert, Annie

doi:10.1177/106002808101500208

Cited by 20 publications

(6 citation statements)

References 5 publications

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“…Photoreactions have been reported to nalidixic acid (Boisvert & Barbeau 1981;Closas et al 1981). A 57-year-old woman was exposed to 15 minutes of direct sunlight 6 days after discontinuing nalidixic acid 1500mg every 6 hours for 4 weeks for a urinary tract infection (Boisvert & Barbeau 1981).…”

Section: Photosensitivitymentioning

confidence: 99%

Clinical Features and Management of Adverse Effects of Quinolone Antibacterials

Paton

Reeves

1991

Drug Safety

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The quinolone antibacterials are proving very useful in the management of infection, notably for the treatment of Gram-negative bacteria. With the increasing use of these drugs, adverse effects are being recognised more often and careful documentation is still required. In general, the quinolones are of low toxicity. Gastrointestinal adverse effects are the most common, and are usually mild; indeed, all adverse events are generally mild and resolve on withdrawal of the offending drug. Certain precautions and contraindications are apparent. Because drug-induced arthropathies occur in juvenile animals, quinolones should not be administered to pregnant or lactating women or to growing children, unless the clinical benefit outweighs the risk. Caution should also be observed in patients with previous epilepsy or severe cerebral arteriosclerosis. Neurological effects may require the use of appropriate neuro- and psychoactive drugs, as well as the withdrawal of the precipitating agent. Hypersensitivity reactions to a fluoroquinolone may require the use of antihistamines, and in some cases topical or systemic steroids, and may well preclude future use of a fluoroquinolone. Dose adjustments may be necessary in patients with reduced renal function, when the measurement of serum concentrations may be desirable. Interstitial nephritis, haematuria and acute renal failure are rare effects of quinolone therapy which will require appropriate management including withdrawal of the precipitating drug. Interactions with theophylline and warfarin are of clinical significance, and may require plasma concentration monitoring and adjustment of dosage.

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Section: Photosensitivitymentioning

confidence: 99%

Clinical Features and Management of Adverse Effects of Quinolone Antibacterials

Paton

Reeves

1991

Drug Safety

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“…As a matter of fact, it is well-known that nalidixic acid, the prototype of quinolone antibacterial agents, occasionally gives rise to serious photosensitivity, as an allergic reaction (1,3,4). Furthermore, clinical development of photosensitivity has been noticed in chemotherapy with fluoroquinolone antibacterial agents, especially with LFLX (2,9,11,12,23).…”

Section: Resultsmentioning

confidence: 99%

Reduced phototoxicity of a fluoroquinolone antibacterial agent with a methoxy group at the 8 position in mice irradiated with long-wavelength UV light

Marutani¹,

Matsumoto²,

Otabe³

et al. 1993

Antimicrob Agents Chemother

109

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A newly developed fluoroquinoline, Q-35 (8-OCH3), in which a methoxy group was substituted at the 8 position of the quinoline nucleus, was very stable under irradiation with long-wave UV light (UVA). Derivatives, a fluoroquinolone with no substitution (the 8-H analog) and one in which a fluorine was substituted (the 8-F analog), were degraded in their solutions by the UVA irradiation. The phototoxic inducibility by these derivatives was further studied in a murine model. When mice were dosed orally with 800 mg of Q-35 (8-OCH3) per kg of body weight, the maximum dose given, and exposed to the UVA light, no inflammatory lesions were observed in their ears. Ear redness was marked in mice given more than 12.5 mg of the 8-F analog or 200 mg of the 8-H analog per kg. Histopathological changes, edema, and infiltration of neutrophils were also observed microscopically in groups receiving the 8-H or 8-F analog but not in groups receiving Q-35 (8-OCH3). Similar inflammatory reactions were observed to occur in a dose-dependent manner with other available fluoroquinolone antibacterial agents such as lomefloxacin, enoxacin, norfloxacin, ciprofloxacin and ofloxacin. These results suggest that the introduction of a methoxy group at the 8 position of the quinolone nucleus is important for the reduction of phototoxicity.

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“…As a matter of fact, NA is clinically known as a photosensitizer (1,3,4), and the photosensitivities of some of fluoroquinolone antibiotics that are on the market have also been reported (2,5,13,14). In order to compare the phototoxicity potentials of these quinolone antibiotics, Wagai et al (21) investigated UVA irradiation (21.6-J/cm2)-induced erythema as a biological marker; the erythema occurs in the ears of mice after oral administration of NA.…”

Section: Discussionmentioning

confidence: 99%

“…However, antibiotics of this class exhibit, although at low frequency, side effects against the digestive and central nervous systems and are known to induce severe photosensitivity on rare occasions (6,12). In particular, nalidixic acid (NA), a prototype fluoroquinolone, is reported to cause photosensitivity in sporadic cases (1,3,4). However, the phototoxic mechanism as the cause of abnormal photosensitivity and its relationship to chemical structures remain unclarified.…”

mentioning

confidence: 99%

Photostability and biological activity of fluoroquinolones substituted at the 8 position after UV irradiation

Matsumoto¹,

Kojima²,

Nagano³

et al. 1992

Antimicrob Agents Chemother

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Q-35 [1-cyclopropyl-6-fluoro-1,4-dihydro-8-methoxy-7-(3-methylaminopiperidine-1-yl)-4-oxoquinoline-3-carboxylic acid], a fluoroquinolone, has absorbance peaks at 333 and 286 nm. No spectral change was observed even when this aqueous solution was irradiated with 3 J of long-wavelength UV light (UVA) per cm2. On the other hand, its derivatives, which are unsubstituted (8-H analog) or which are substituted with fluorine at the 8 position (8-F analog), were found to have decreased antibacterial activities with a simultaneous increase in their cytotoxicities when they were degraded in a dose-dependent manner with respect to UVA irradiation. Similar results were observed with the other available fluoroquinolones. Enoxacin and lomefloxacin exposed to 0.3 J of irradiation per cm2 and norfloxacin, ofloxacin, and ciprofloxacin exposed to 1 J of irradiation per cm2 underwent absorption spectrum changes, an accompanying decrease in antibacterial activity, and an increase in cytotoxic activity. These results suggest that the introduction of a methoxy group into the 8 position of quinolones plays an important role in the stability of fluoroquinolones against irradiation by UV light.

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Nalidixic Acid-Induced Photodermatitis after Minimal Sun Exposure

Cited by 20 publications

References 5 publications

Clinical Features and Management of Adverse Effects of Quinolone Antibacterials

Clinical Features and Management of Adverse Effects of Quinolone Antibacterials

Reduced phototoxicity of a fluoroquinolone antibacterial agent with a methoxy group at the 8 position in mice irradiated with long-wavelength UV light

Photostability and biological activity of fluoroquinolones substituted at the 8 position after UV irradiation

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