Myasthenia Gravis Support Group
Myasthenia gravis (MG) is a neuromuscular disease leading to fluctuating muscle weakness and fatiguability. The hallmark of myasthenia gravis is muscle weakness that increases during periods of activity and improves after periods of rest. Although myasthenia gravis may affect any voluntary muscle, muscles that control eye and eyelid movement, facial expression, and...
I was at an ENT clinic today and had the doctor look at my ears because I think they had fluid in them. He promptly picked up a bottle of ear drops and put them in my ear, explaining that they were an antibiotic. I didn't think much of it because I've had topical neomycin/polymyxin b/hydrocortisone ear drops before with no problem and with the approval of my neurologist (caution is usually advised when using neomycin and polymyxin with myasthenia). However, the script for the ear drops that he gave me is ofloxacin and as a flouroquinolone I hear it is nasty stuff and there's all this stuff about people having crises with it and what-not. Of course, these are just ear drops, and there doesn't appear to be warnings for myasthenics on the monographs for the ear drops like there are for the tablets, so I'm hoping there is nothing to worry about.
You know, I guess I'm just seeing if anyone out there heard from their own doctor that this stuff is OK as ear drops, or used it themselves as ear drops with no problem, so I'll stop worrying.
On another note, I really hate when doctors are aggressive during your visit. "Here, do this." and the like.
Generally ofloxacin is on the list of antibiotics that could exacerbate mg muscle weakness. It is in the category of Quinolone antibiotics which are listed as "Quinolone antibiotics.
There have been a number of cases of acute exacerbation with Ciprofloxacin and Norfloxacin. Caution should also be exercised with others in the family (e.g. Moxifloxacin) as it is thought that quinolones directly affect neuromuscular transmission."
That said, it is different when you use creams or drops:
"In general, the antibiotics most likely to cause problems are only available as intramuscular and intravenous preparations, and therefore likely to be used only in the hospital setting or are only available as topical preparations (e.g. eye/ear drops, creams) and unlikely to cause problems as so little is absorbed into the body. In the general practice setting, Norfloxacin, Ciprofloxacin, Erythromycin, Azithromycin and the Tetracyclines are the antibiotics to use with caution. It is best to simply choose the appropriate oral antibiotic and remain watchful for increasing weakness, particularly difficulty swallowing or breathing. Remember that acute illness, dehydration and fever can also worsen the MG."
As to aggressive doctors--I have been lucky and not had very many, and now, maybe because both my neuro and family doctor are women, I find both spend time explaining their treatment plans to me and asking me to be aware of my own symptoms. I have bumped into aggressive surgeons, who I just patiently insist on them explaining the "why" of whatever treatment is planned. I am using their services and paying highly for the visit, and so insist on getting my questions answered. I consider that persistence in my case rather than aggression ;-)
Good Luck,
Russ