INTERNATIONAL SEVERE WARNING REQUIREMENTS AND SMART DECISIONS IN CHOICE TACTICS FOR FLUOROQUINOLONES

The paper is devoted to the review of the reports on current ideas about adverse reactions of using the fluoroquinolones. As a group of antibiotics with a wide range of effects on microbial pathogens, they have recently found a sufficient use in infectious diseases in clinical practice. However, the spread of indications is accompanied by the accumulation of information about the growth of adverse reactions. Among the first mentioned ones there were reactions in gastrointestinal tract, allergic reactions, photosensitization, prolongation of the QT interval, deterioration of joint and tendon function, lesions of the nervous system. Some toxic reactions contributed to the banning of certain drugs: temafloxacin, grepafloxacin, trovafloxacin. Further observations were made on the development of hypoglycemic reactions, eosinophilia, liver damage. Among the mechanisms of toxicity the free radical reactions, structural modifications of the antibiotic molecule are considered. Therefore, both the United States (FDA) and European experts are paying close attention to serious warnings to limit the indications for these drugs. Some studies have shown an increase in the frequency of tendon rupture, as well as the risk of aortic aneurysm and its rupture, due to the mechanisms of effects on collagen metabolism, widely present in the tissues of the joints and surrounding tissues and in the aorta. The reports demonstrate the frequency of lesions to joints, muscles, nervous system and separately formulated complications in the mental sphere of patients. The accumulation of information on the injury of the nervous system and mental disorders resulted in the proposal to limit the indications for the easy course of infections, with their recurrence in urinary tract infections, diarrhea prevention. Restrictions also include as follows: old age of patients, previous anamnestic reactions to these drugs, diseases of the joints and kidneys, interaction with glucocorticoids. Key words: fluoroquinolones, adverse reactions, restrictions on indications, international recommendations.