Quinolones


Synthetic antibiotics first generation quinolones were used for treatment of urinary tract infections because of their rapid excretion by kidney.
 
New quinolones are used in various systemic infections.
 
First generation: Nalidixic acid, Oxolinic acid, Pipemidic acid, Flumequin
 
Second generation: Pefloxacin, Norfloxacin, Ofloxacin, Ciprofloxacin, Enoxacin, Lomefloxacin
 
Third generation: Sparfloxacin.
 
Incidence
18 to 23/10 million days of treatment.
 
In France 43 cases of anaphylaxis to quinolones were transmitted to pharmacovigilance in 1992 (first generation quinolones were almost always involved).
 
Risk factors
AIDS.
 
Female gender.
 
Sun exposure (photosensitivity).
 
Past exposure to quinolones or related compounds (Chloroquine, Glafenine, Tiliquinol, Nitroxolin).
 
Clinical manifestations
General: anaphylactic shock, fever, arthralgias.
 
Cutaneous: maculopapular or bullous exanthema, pruritus, angioedema, fixed drug eruption and rarely Stevens-Johnson or Lyell’s disease (enoxacin, sparfoxacin and lomefloxacin are well-known to cause photosensitivity).
 
Differentiate from other side effects: gastrointestinal disturbance, neuropsychiatric manifestations.
 
Diagnostic methods
Cutaneous testing
 
Skin- prick tests and intradermal tests give false positive results.
 
Photo-patch tests with lomefloxacin are usually negative and cross-sensitivity with other quinolones is rarely reported.
 
Specific IgE: none.
 
Challenge test: 11 cases published.
 
Cross-reactivity between first and second generation quinolones +++.
 
Mechanisms
Unknown.
 
Management
Eviction (all quinolones).
 
If absolutely necessary: desensitization.
 
Ciprofloxacin 0,05 mg to 150 mg (3H).

References

  1. Kimura M, Kawada A, "Photosensitivity induced by lomefloxacin with cross-sensitivity to ciprofloxacin and fleroxacin", Contact. Dermatitis., 1998 ; 38: 180
  2. Bircher A.J, Rutishauser M, "Oral "desensitization" of maculopapular exanthema from ciprofloxacin", Allergy. , 1997 ; 52: 1246-8
  3. Arboit F, Bessot J.C, Deblay F, Dietemann A, Charpentier C, Pauli G, "L’allergie aux quinolones. A propos de huit observations", Rev. Fr. Allergol., 1997 ; 37 (1): 15-9
  4. Lantner RR, "Ciprofloxacin desensitization in a patient with cystic fibrosis", J. Allergy.Clin. Immunol., 1995 ; 96: 1001-2
  5. Davila I, Diez M.L, Quirce S, Fraj J, de La Hoz B, Lazaro M, "Cross reactivity between quinolones. Report of three cases", Allergy 1993 ; 48: 388-90

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.