Photoreactions with a fluoroquinolone antimicrobial: Evening versus morning dosing

Lowe, Nicholas J.; Fakouhi, T; Stern, Robert S.; Bourget, Teresa; Roniker, Barbara; Swabb, Edward A.

doi:10.1038/clpt.1994.180

Cited by 41 publications

(9 citation statements)

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“…It has been suggested that an evening dosing excess of reports in women. Interestingly, we found that the female/male ratio of reported skin reactions in strategy may reduce the risk of inducing phototoxic effects [37]. children aged under 10 years was about 0.9.…”

mentioning

confidence: 97%

Cutaneous reactions to drugs. An analysis of spontaneous reports in four Italian regions

Naldi

Conforti

Venegoni

et al. 1999

Brit J Clinical Pharma

160

118

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Aims Cutaneous manifestations are frequently reported in association with drug use. The aim of this study was to analyse the skin reactions reported to the spontaneous surveillance systems of four Italian regions (Friuli Venezia Giulia, Lombardy, Sicily and the Veneto), and correlate the reports with estimated drug consumption during the same period, paying particular attention to the reactions to antimicrobial agents and nonsteroidal anti-inflammatory drugs (NSAIDs). Methods All of the adverse drug reactions (ADRs) reported spontaneously between January 1996 and December 1997 to the surveillance systems of four Italian regions (a total population of about 20 million people) were analysed by a panel of experts including dermatologists. On the basis of the Critical Term List of the World Health Organization (WHO), the reactions were classified as either serious or nonserious events. Drug consumption was expressed as a daily defined dose (DDD)/1000 inhabitants/day. Results A total of 2224 adverse skin reaction reports (44.7% of all of the reported ADRs) were identified, making a reporting rate of about 5.5 per 100 000 inhabitants/year. The female/male ratio was 1.58, and the reporting rate progressively increased with age. The drug categories with the highest number of cutaneous reactions were antimicrobials, followed by NSAIDs, analgesics and radiology contrast media. There was a total of 372 (16.9%) serious reaction reports, the most frequent being angioedema (171 cases), erythema multiforme (68 cases) and photosensitivity (37 cases). Co-trimoxazole, followed by the cephalosporins and fluoroquinolones, were associated with the highest consumption-related reporting rate among the antimicrobials, and aspirin and dipyrone among the NSAIDs and analgesics. Conclusions Spontaneous reports from four Italian regions revealed that the skin was the organ most frequently affected by ADRs. The paper shows the validity of a regional decentralized system in Italy. health service use and costs [4, 6]. Keywords

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mentioning

confidence: 97%

Cutaneous reactions to drugs. An analysis of spontaneous reports in four Italian regions

Naldi

Conforti

Venegoni

et al. 1999

Brit J Clinical Pharma

160

118

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“…Alternatively, adverse reactions can be minimised by taking the drug at the end of the day. Although this last recommendation was not sufficient in our patient 5, who took it regularly at 11 p.m., in a prospective study it was observed that whereas an evening dose of lomefloxacin induced no modification of the MED for UVA (tested at day time), a statistically significant reduction was observed when the drug was taken in the morning (29).…”

Section: Discussionmentioning

confidence: 61%

Photosensitivity to lomefloxacin. A clinical and photobiological study

Oliveira

Gonçalo

Figueiredo

2000

Photoderm Photoimm Photomed

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Photosensitivity is an uncommon but characteristic side effect of quinolones, with a variable incidence for the different drugs. Several cases, considered either phototoxic or photoallergic, have been described with lomefloxacin use. During the last 4 years we studied 8 patients (mean age 69.4 years) with eczematous or acute sunburn-like lesions in photo-exposed areas, after taking lomefloxacin for a period of one week to several months. After drug withdrawal and systemic and/or topical corticosteroids, lesions cleared within one week to two months, with dischromia in one patient. Six to eight weeks thereafter, a photobiological study was performed. Minimal erythema dose (MED) for UVA and UVB were normal and photopatch tests with lomefloxacin, ofloxacin, ciproflaxacin and norfloxacin, tested at 1%, 5% and 10% in petrolatum and irradiated with 5 and 10 J/cm2 UVA were negative in 7 patients and 20 controls. Patient 1 had a positive photopatch test with lomefloxacin. One patient, who inadvertently reintroduced the drug before photopatch testing, developed a sharply limited erythematous reaction at 48 h in all irradiated areas, without aggravation at the sites of the quinolones patches. Our patients illustrate the polymorphism of clinical photosensitivity to lomefloxacin and represent the largest series in which photobiological studies have been performed. As in previous reports there are arguments favouring photoallergy, but phototoxicity appears to be the main mechanism of photosensitivity to quinolones, particularly in older patients with concomitant diseases and long-term use of the drug.

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“…Fluoroquinolone photosensitivity may therefore be reduced by evening dosing leading to lower skin levels at the time of maximum sunlight exposure. 4,16,17 Again, the mechanism involves an energy transfer from the photoexcited chromophore (the parent compound or a photoproduct) to molecular oxygen with the generation of reactive oxygen species after sun exposure. 1,18 Nonsteroidal Antiinammatory Agents NSAIDs, which are designed to alleviate inflammatory responses, are themselves a significant cause of inflammation when combined with sunlight exposure.…”

Section: Antibioticsmentioning

confidence: 99%