⚠ Antibiotics with the WORST Side Effects (Dangerous Antibiotics) Fluoroquinolones

Summary

Dr. Ken Berry, a family physician, discusses the overprescription of fluoroquinolone antibiotics, which have serious black box warnings for side effects like tendon damage and nerve issues. He highlights that many infections treated with these powerful antibiotics are viral or could be addressed with safer alternatives. Dr. Berry emphasizes the importance of informed consent and questions why doctors continue prescribing such strong medications out of habit or patient expectation. He urges patients to be vigilant and proactive in discussing risks with their doctors before accepting these prescriptions.

Takeaways

• ⚠️ Many doctors overprescribe fluoroquinolone antibiotics, even for mild infections, despite their serious side effects.
• 🦠 Most sinus and bronchial infections are viral, meaning antibiotics like fluoroquinolones are ineffective in 85% of cases.
• 💊 Fluoroquinolones are often used unnecessarily for infections that can be treated with safer antibiotics.
• ⚕️ Doctors should inform patients about the potential severe side effects of fluoroquinolones and obtain informed consent before prescribing.
• 🦵 The black box warning for fluoroquinolones includes risks of irreversible tendon damage, tendonitis, and peripheral neuropathy.
• 🚨 Fluoroquinolones can also cause psychological side effects like anxiety, psychosis, and suicidal thoughts.
• 💡 Doctors may prescribe these antibiotics out of habit or because they feel pressured by patients expecting a prescription.
• 🧠 If a doctor prescribes fluoroquinolones, they should clearly explain that there are no safer alternatives for the specific infection.
• 🏥 These antibiotics are only appropriate in severe, life-threatening cases, such as hospital or ICU settings, where no other options work.
• 📋 Patients should memorize or keep a list of fluoroquinolone drugs and discuss risks with their doctor if prescribed one.

Q & A

What is the main concern Dr. Ken Berry raises about certain antibiotics?

Dr. Ken Berry raises concerns about the overprescription of fluoroquinolones, a class of antibiotics, which are often prescribed for infections that do not require such strong medications. These antibiotics carry serious risks, including irreversible tendon and nerve damage.

What are some common infections fluoroquinolones are often prescribed for, according to Dr. Berry?

Fluoroquinolones are often prescribed for sinus infections, bronchitis, skin infections, and bladder infections, even though these are frequently viral and do not require antibiotics, or could be treated with safer antibiotics.

Why are fluoroquinolones considered risky, as per the video?

Fluoroquinolones come with a Black Box warning, the most severe type of warning by the FDA, due to their potential to cause irreversible damage to tendons (tendonitis, tendon rupture) and peripheral nerves (peripheral neuropathy).

What percentage of sinus and bronchial infections are viral, and why is this significant?

According to Dr. Berry, 85% of sinus and bronchial infections are viral, which is significant because antibiotics, including fluoroquinolones, do not treat viral infections. Prescribing them in such cases is unnecessary and risky.

What should a doctor do before prescribing fluoroquinolones, according to Dr. Berry?

Doctors should thoroughly evaluate whether fluoroquinolones are truly necessary. They must also discuss the potential risks with patients and obtain informed consent, ensuring the patient understands the possible irreversible side effects before prescribing these antibiotics.

What does Dr. Berry mean by 'informed consent,' and why is it important?

Informed consent refers to the doctor discussing the serious risks associated with fluoroquinolones with the patient before prescribing. It ensures the patient is fully aware of potential side effects, such as irreversible nerve damage, before agreeing to take the drug.

In what situations does Dr. Berry believe it is appropriate to use fluoroquinolones?

Fluoroquinolones should only be used in serious infections when no other antibiotic will work, or in life-threatening situations where the benefits outweigh the risks. They are inappropriate for outpatient settings where other, safer antibiotics are available.

What are some of the other serious side effects of fluoroquinolones mentioned in the video?

In addition to tendon and nerve damage, fluoroquinolones can cause muscle pain, joint swelling, psychosis, anxiety, insomnia, depression, hallucinations, and gastrointestinal issues like C. difficile-associated diarrhea.

Why do some doctors overprescribe fluoroquinolones, according to Dr. Berry?

Dr. Berry suggests that some doctors overprescribe fluoroquinolones out of habit, convenience, or due to pressure from patients expecting antibiotics. He also mentions that some doctors may not take the time to explore safer alternatives.

What advice does Dr. Berry give to patients prescribed a fluoroquinolone?

Dr. Berry advises patients to ask their doctor why a fluoroquinolone is being prescribed, inquire about the Black Box warning, and discuss whether there are safer alternatives. He emphasizes the importance of informed consent before accepting the prescription.

Outlines

00:00

⚠️ Antibiotics Misuse and Overprescription Alert

Dr. Ken Berry emphasizes the overprescription of a class of antibiotics called fluoroquinolones, which have serious risks. Despite being overused for common infections like sinusitis, bronchitis, and urinary tract infections—many of which are viral and don’t need antibiotics—these drugs continue to be prescribed unnecessarily. He explains that there are six FDA-approved fluoroquinolones, and these should not be used casually because of their Black Box warning, which highlights potential harm to patients.

05:00

🚨 Black Box Warnings: Tendon and Nerve Damage Risks

Fluoroquinolones have a Black Box warning due to risks of irreversible damage to tendons and peripheral nerves. Dr. Berry discusses conditions like tendonitis, tendon rupture, and peripheral neuropathy that can result from these drugs, potentially leading to permanent damage. He stresses the importance of informed consent, where doctors should discuss these risks with patients before prescribing fluoroquinolones, especially in cases of serious conditions like myasthenia gravis, where the risks could outweigh the benefits.

10:00

🤔 The Importance of Informed Consent Before Taking Fluoroquinolones

Dr. Berry underscores the concept of informed consent, explaining that patients must be fully aware of the risks before taking fluoroquinolones. He highlights that doctors often fail to discuss the Black Box warnings with patients, depriving them of their right to make an informed decision. He advises that these drugs should only be used when absolutely necessary, such as when no other antibiotics work or the infection is life-threatening.

Keywords

💡Fluoroquinolones

Fluoroquinolones are a class of powerful antibiotics used to treat bacterial infections. In the video, Dr. Ken Berry warns that these drugs, such as ciprofloxacin and levofloxacin, are often overprescribed, especially for infections like sinusitis or bronchitis, which are usually viral. The main message highlights the risks of using fluoroquinolones unnecessarily, including severe side effects like tendon damage and peripheral neuropathy.

💡Black Box Warning

A black box warning is the most serious warning issued by the FDA, indicating that a drug carries a significant risk of severe or life-threatening side effects. The video emphasizes that all fluoroquinolones carry this warning due to the potential for irreversible harm, such as tendon rupture and nerve damage. Dr. Berry argues that doctors often fail to inform patients of these risks, undermining the concept of informed consent.

💡Informed Consent

Informed consent refers to the process by which a doctor provides a patient with all necessary information about the risks and benefits of a treatment, allowing the patient to make an educated decision. The video stresses that many doctors neglect to explain the dangers of fluoroquinolones before prescribing them, depriving patients of the opportunity to make informed choices about their treatment.

💡Sinus Infection

A sinus infection, or sinusitis, is inflammation of the sinuses often caused by viruses. Dr. Berry explains that antibiotics, particularly fluoroquinolones, are commonly prescribed for sinus infections, even though 85% of these cases are viral and do not require antibiotics. The inappropriate use of antibiotics for viral infections is a central point in the video, illustrating the problem of overprescription.

💡Tendon Rupture

Tendon rupture refers to the tearing of a tendon, a potential side effect of fluoroquinolones. Dr. Berry highlights tendon rupture as one of the serious, potentially irreversible risks associated with these antibiotics. This risk is part of the black box warning, but many patients are not informed about it before being prescribed the medication.

💡Peripheral Neuropathy

Peripheral neuropathy is a condition involving damage to the peripheral nerves, causing pain, weakness, or numbness, often in the hands and feet. The video notes that fluoroquinolones can cause permanent peripheral neuropathy, a fact that is part of the black box warning. Dr. Berry emphasizes that this serious side effect is often not discussed with patients, leading to uninformed use of these drugs.

💡Antibiotic Resistance

Antibiotic resistance is a phenomenon where bacteria evolve to resist the effects of antibiotics, making infections harder to treat. While the term is not explicitly mentioned in the video, it is implied through the discussion of overprescribing antibiotics for viral infections, which contributes to this growing global problem. Dr. Berry warns against using fluoroquinolones unnecessarily, as this can contribute to resistance.

💡Overprescription

Overprescription refers to the practice of prescribing medications more frequently than necessary. Dr. Berry critiques the common practice of prescribing fluoroquinolones for minor or viral infections, which often don't require antibiotics at all. The video suggests that overprescription occurs due to habit or patient expectations, rather than medical necessity.

💡Viral Infection

A viral infection is caused by viruses, which antibiotics cannot treat. The video emphasizes that many infections, such as sinusitis and bronchitis, are viral, yet doctors often prescribe antibiotics like fluoroquinolones, which are ineffective against viruses. This misuse is a central issue discussed, as it leads to unnecessary exposure to harmful side effects.

💡C. difficile Infection

C. difficile, or Clostridium difficile, is a bacterial infection that can cause severe diarrhea and intestinal issues, often as a result of antibiotic use. In the video, Dr. Berry warns that fluoroquinolones can 'carpet bomb' gut bacteria, leading to imbalances that allow harmful bacteria like C. difficile to thrive. This highlights another serious potential side effect of overusing powerful antibiotics.

Highlights

Doctors are often prescribing a class of antibiotics known as fluoroquinolones, which have a serious FDA Black Box warning.

The fluoroquinolone antibiotics include drugs like ciprofloxacin, levofloxacin, and moxifloxacin.

These antibiotics are frequently over-prescribed for common infections like sinus infections, bronchitis, and bladder infections.

85% of sinus infections, bronchitis, and similar conditions are caused by viruses, which antibiotics, including fluoroquinolones, do not treat.

For bacterial infections, safer, less harmful antibiotics are available, and should be prescribed instead of fluoroquinolones.

Fluoroquinolones carry risks of irreversible damage to tendons, peripheral nerves, and can cause tendonitis, tendon ruptures, and peripheral neuropathy.

Patients with myasthenia gravis should never take fluoroquinolones unless carefully prescribed by a specialist due to increased risks.

Doctors are expected to provide informed consent, meaning they should discuss the serious risks with patients before prescribing these antibiotics.

Common side effects of fluoroquinolones include muscle pain, joint pain, psychosis, anxiety, depression, and even suicidal thoughts.

Fluoroquinolones also disrupt gut bacteria, leading to severe gastrointestinal issues like C. difficile-associated diarrhea.

These drugs are often prescribed out of habit or due to patient expectations, even though safer alternatives exist.

Patients should be vigilant and question their doctors if they are prescribed a fluoroquinolone for a minor infection.

In cases where fluoroquinolones are prescribed, doctors should explain that there are no other antibiotics that can effectively treat the infection.

Fluoroquinolones should only be used in life-threatening infections when the benefits outweigh the risks, especially in outpatient settings.

This over-prescription of fluoroquinolones can be considered inappropriate or borderline malpractice when safer options are available.

Transcripts

I shouldn't have to make this video and

you should not have to watch this video

but when the level of the average

doctor's laziness and or

incompetence reaches a certain level

then I have to reach out to you and say

hey you need to be aware of this even

though you're not a doctor and it's not

your job

this is very important this is about a

class of antibiotics that are very much

over over prescribed in the United

States and in other countries that have

a serious Black Box warning

own the package insert and that harm

thousands of patients a year that should

not be prescribed for common infections

yet still are each and every day I'm Dr

Ken Berry a family physician let me

explain what's going on to you so that

you can be prepared to protect your

yourself and your family in case your

doctor is just not willing to do the job

that they signed up to do

there are currently six different drugs

that are FDA approved in this drug class

and I'm going to put a visual up so you

can look at this maybe take a screenshot

come back and watch this again later and

write these down moxifloxacin

ciprofloxacin ciprofloxacin extended

release

jimifloxacin

levofloxacin andofloxacin these are the

fluoroquinolones

these drugs are very commonly prescribed

by primary care doctors for such such

inconsequential infections as sinus

infections bronchitis skin infections

and bladder infections urinary tract

infections now first and foremost you

should understand that the vast majority

of sinus infections and bronchitis

are caused by viruses which no

antibiotic fights or treats or improves

at all so 85 percent of the time if you

have a sinus infection or an ear

infection or a bronchial infection or a

throat infection

it's a virus no antibiotic on the planet

is going to shorten the amount of time

you're sick is going to fight the virus

is going to heal you faster the average

doctor should know this many of them

seem not to know this at all

so very commonly for a sinus infection

either Levaquin levofloxacin or Cipro

ciprofloxacin is prescribed for a sinus

infection which uh 85 of the time is

viral and the other 15 of the time if it

is bacterial

there are other less harmful less severe

less powerful antibiotics that will

treat the bacterial sinus infection just

fine without all the disastrous side

effects and complications that I'm going

to tell you about in just a minute that

come along with this drug class the same

goes for bronchitis the vast majority of

the time it's viral you don't need an

antibiotic at all in the 15 percent of

cases that are bacterial there are very

inexpensive very safe antibiotics that

will treat that bronchitis just fine

without you having all the potential

side effects that come along with the

fluoroquinolones same goes for bladder

infections and pelvic infections 85

percent of the time they're viral or

fungal uh 15 of the time they are

bacterial but you can take a much

cheaper much safer antibiotic for them

so the question becomes is why are

primary care doctors why are Internal

Medicine doctors Family Medicine doctor

years OB gyns pediatricians uh

gerontologists why are they prescribing

this basically an a nuclear bomb

when all that is needed is just a small

caliber rifle why are they doing that

well

the majority of the time it's out of

habit they've been prescribing Cipro for

bladder infections for years or they've

been prescribing levofloxacin for sinus

infection for years that's just what

they do that's the only tool that they

know how to use in the toolbox

many primary care doctors think that you

expect

to receive an antibiotic prescription if

you have some sort of infection that you

went to the doctor to get checked and

indeed that is true with some patients

they they expect a prescription for an

antibiotic and they'll get upset if they

don't get one now that does Place some

extra pressure on the primary care

doctor to prescribe an antibiotic but

that still doesn't mean that they should

and it definitely does not mean that

they should prescribe one of these

fluoroquinolones so every single drug in

this drug class has a black box warning

that the Physicians should 100 percent

know about

and should 100 of the time discuss with

you before they write the prescription

and before you accept the prescription

fill the prescription and take the

prescription so in this particular case

all of the fluoroquinolones contain a

black box warning saying that they they

could potentially cause irreversible

damage to tendons and to peripheral

nerves so uh tendonitis tendon rupture

peripheral neuropathy these things can

not only happen but they could be

permanent

very very very concerning uh if you have

myasthenia gravis then you absolutely

should never take a fluoroquinolone

unless it's given to you by a specialist

after you've had the discussion hey I

have mg are you sure I should take Cipro

uh and them say yes I understand there

is a risk but the benefits outweigh the

risks so every doctor before they give

you

one of these fluoroquinolones

they should have first of all have an

internal discussion in their own brain

whether they should be writing this

prescription or Not For What diagnosis

they've given you

but every single patient who receives

the fluoroquinolone should give informed

consent

before they take that

antibiotic and what that means is that

the doctor actually had a discussion

with you hey this has got a black black

box box warning it could cause permanent

nerve damage it could cause

permanent tendinitis I just wanted you

to be aware of that I think you need

this antibiotic do you accept the risks

of this antibiotic to which the patient

would either say uh yes or hell no and

that's what informed consent means so

how many of you guys have been given

Cipro or Levaquin or avilox and you're

like no the doctor didn't tell me there

was a black box warning no they didn't

tell me I could have permanent nerve

damage

from taking that so you were not given a

chance to give your doctor informed

consent to use that treatment on you I

think that's kind of a big deal the only

time you should be given a

fluoroquinolone and accept one from your

doctor for a sinus infection a lung

infection or a bladder infection is if

number one the doctor discussed this

with you and you gave informed consent

but and also the doctor said look there

is no other antibiotic that this

bacteria is susceptible to this is the

only one that will work or your

infection is so serious that I think it

endangers your life therefore the the

benefits of taking this fluoroquinolone

outweighs the risks otherwise

that you should never take a

fluoroquinolone in an outpatient setting

now if you're an inpatient in a hospital

especially if you're in the Intensive

Care Unit if you're close to death then

of course we're going to pull out all

the big guns as a doctor and we might

give you things that have potential

potentially significant risks

just to get the benefits that they may

give you because there may be no other

antibiotic in the pharmacy that's going

to save your life but if you're in an

outpatient setting you went to a

doctor's office or an urgent care and

they give you levofloxacin ciprofloxacin

any of the fluoroquinolones and they

don't let you give informed consent and

they don't tell you hey there's no other

drug that will fix this if basically

what happens is they're like I'm a lazy

ass doctor and I don't want to really

look anything up so I've been giving

Cipro for years for sinus infection so

that's what you're going to get that's

completely inappropriate and borderline

malpractice

so the things mentioned in the Black Box

warning are not the only disaster side

effects that the fluoroquinolones are

known for they're also known for muscle

pain muscle weakness joint pain joint

swelling

psychosis anxiety insomnia depression

Suicidal Thoughts hallucinations

and then you can see from the rest of

this chart several of the things now

keep in mind that all the

fluoroquinolones are very powerful

antibiotics and so they're basically

going to carpet bomb your gut bacteria

and so you could wind up having C

difficile Associated diarrhea or a whole

host of other gastrointestinal symptoms

from bloating to diarrhea to

constipation to gut pain to cramping

because you basically carpet bombed all

of the nice friendly bacteria in your

guts so I'm going to put the list of

medications and these are only the ones

that are FDA approved in the United

States if you're in another country

there's quite possibly other brand names

that are not on this list and there may

even be other fluoroquinolones generics

that are not on this list so you're

going to have to do your due diligence

since it's very obvious from the number

of prescriptions written

uh that that pharmacies keep a tally up

that doctors are still grossly over

prescribing the fluoroquinolones for

infections that they should never be

prescribed for so I want you to memorize

this list maybe even print this out and

keep this in your wallet or your purse

uh and then anytime you go to the doctor

with an infection when they give you an

antibiotic prescription you're going to

look on this list and see if it's one of

these and if it is you're going to have

a discussion with your doctor at that

point and say Doc why didn't you tell me

there was a black box warning for this

drug why didn't you tell me that this

could cause Suicidal Thoughts is there

not another antibiotic that you could

have given me besides Cipro or

levofloxacin is that really that's

that's the one that you're going to give

me and after that conversation I think

from that day forward your doctor will

perhaps be on his or her toes as they

should have been anyway and won't make

such a dastardly mistake again I put

links to the FDA web side about the

fluoroquinolones down in the show notes

below please be vigilant we should be

able to trust our doctors when we go to

them with a complaint but very often

we're not able to trust our doctors and

therefore you have to be more Vigilant

when you go to the doctor than you

should have to be I'm sorry about that

but I also want you to be aware this is

Dr Barry I'll see you next time