Prasanth Puthanveetil, BPharm, PhD

Antibiotics are used to either eliminate microbes or stunt their growth. They are meant to limit the pathogen attack that is debilitating the host’s systemic function.

In recent years, health care professionals have been seeing a surge in adverse effects associated with long-term use of antibiotics, as well as abuse, not only in the United States, but around the world.

This brawl with antibiotics has been happening for some time and is reported based on observed adverse events or clinical studies conducted globally.

Is the trajectory a sign of highly evolving microbes, due to pattern of regimen we are currently following, or is it due to the influence and contribution of other diseases?

These concerns are yet to be identified and addressed.

 However, pharmacists have a key role and responsibility in identifying and addressing factors that could help limit adverse events associated with long-term use of antibiotics.

Some studies have provided evidence that administration of antibiotics like β-lactamase inhibitors, macrolides, and fluoroquinolones is associated with increased incidence of ventricular arrhythmias and cardiovascular deaths.

One of earliest reported studies on the association between fluoroquinolones and aortic aneurysm and aortic dissection was from Taiwan, based on evidences acquired from 1477 patients.

 Systemic review and meta-analysis studies showed that the role of fluoroquinolones to be a major player in inducing aortopathy, which includes aneurysm and dissection.

These reports do not mean that only fluoroquinolone are the problem creators. There is also evidences obtained from various other studies claiming that macrolide antibiotics are associated with cardiovascular complications and death.

Some recent reports even demonstrate that elderly women are more prone to cardiovascular events and deaths when administered antibiotics long term.

 This study doesn’t mention the effects of 1 specific class of antibiotics, but rather focused on duration. It also emphasized that irrespective of the class, antibiotics, administered long term could cause cardiovascular events or intensify the cardiovascular risk especially in elderly women population.

Even though the focus was on the effects of antibiotics, some of these studies also mention that the underlying infection can also debilitate the cardiovascular function which could be directly or indirectly contributing towards this risk.

In December 2018, FDA issued a warning on fluoroquinolone antibiotic use, stating that this class causes rare but serious adverse events, like aortic tear or rupture ultimately leading to bleeding and death.

Pharmacists have a major role and responsibility in following the drug regimen for patients suffering from infections to make sure that the patients don’t succumb to infections, but at the same time, do not pay the penalties for administering antibiotics.

A stringent evaluation and follow up on the dose, duration and frequency of antibiotic administration should be exercised by pharmacists with consideration for the age, gender, disease background, and health history of each patient.  In this way, we will be able to depose the number of severe adverse effects seen with the use of antibiotics.

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Prasanth Puthanveetil, BPharm, PhD

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