{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T22:33:22Z","timestamp":1784759602862,"version":"3.55.0"},"reference-count":75,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T00:00:00Z","timestamp":1639612800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["CA102713"],"award-info":[{"award-number":["CA102713"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Fluoroquinolones (FQs) are a broad-spectrum class of antibiotics routinely prescribed for common bacterial infections despite recent recommendations to use them only for life-threatening cases. In addition to their antimicrobial properties, FQs act in the central nervous system as GABAA receptor inhibitors, which could potentially affect functionality of the vagus nerve at the forefront of gastrointestinal (GI) tract function. Alterations in neural control of digestion have been shown to be linked to Functional Gastrointestinal Disorders (FGIDs), which are usually diagnosed based on self-reported symptoms. The aim of this study was to assess the incidence of FGIDs following FQ use. Materials and Methods: Self-reports from the FDA Adverse Event Reporting System were analyzed together with ~300 survey responses from a social network derived sample to the Bowel Disease Questionnaire. Results: The results of this study suggested that six different FQs are associated with a wide range of GI symptoms not currently reported in the drugs\u2019 labels. The responses from the survey suggested that ~70% of FQ users scored positive for FGID, with no positive correlation between drug type, duration of administration, dosage and frequency of administration. Conclusions: This study showed that GI disorders other than nausea, vomiting and diarrhea are more common than currently reported on the drug labels, and that FGIDs are possibly a common consequence of FQ use even after single use.<\/jats:p>","DOI":"10.3390\/medicina57121371","type":"journal-article","created":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T21:32:40Z","timestamp":1639690360000},"page":"1371","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["A New Criterion for Fluoroquinolone-Associated Disability Diagnosis: Functional Gastrointestinal Disorders"],"prefix":"10.3390","volume":"57","author":[{"given":"Deanna N.","family":"Cannizzaro","sequence":"first","affiliation":[{"name":"Department of Biology, Bucknell University, Lewisburg, PA 17387, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia F.","family":"Naughton","sequence":"additional","affiliation":[{"name":"Department of Biology, Bucknell University, Lewisburg, PA 17387, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1587-4651","authenticated-orcid":false,"given":"Maya Z.","family":"Freeman","sequence":"additional","affiliation":[{"name":"Department of Biology, Bucknell University, Lewisburg, PA 17387, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Martin","sequence":"additional","affiliation":[{"name":"SONAR (Southern Network on Adverse Reactions) Program, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles L.","family":"Bennett","sequence":"additional","affiliation":[{"name":"SONAR (Southern Network on Adverse Reactions) Program, University of South Carolina College of Pharmacy, Columbia, SC 29208, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4223-9477","authenticated-orcid":false,"given":"Cecilia","family":"Bove","sequence":"additional","affiliation":[{"name":"Department of Biology, Bucknell University, Lewisburg, PA 17387, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,16]]},"reference":[{"key":"ref_1","unstructured":"(2021, August 25). Fluoroquinolones|A.R. & Patient Safety Portal, Available online: https:\/\/arpsp.cdc.gov\/profile\/antibiotic-use\/fluoroquinolones."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1021\/bi5000564","article-title":"Mechanism of Quinolone Action and Resistance","volume":"53","author":"Aldred","year":"2014","journal-title":"Biochemistry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1002\/1615-1003(200109)30:5<412::AID-PAUZ412>3.0.CO;2-N","article-title":"Well tolerated or risky? Adverse effect of quinolones","volume":"30","author":"Stahlmann","year":"2001","journal-title":"Pharm. Unserer Zeit"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1212\/WNL.0000000000002633","article-title":"Association between oral fluoroquinolones and seizures","volume":"86","author":"Chui","year":"2016","journal-title":"Neurology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1212\/WNL.0000000000000846","article-title":"Oral fluoroquinolone use and risk of peripheral neuropathy: A pharmacoepidemiologic study","volume":"83","author":"Etminan","year":"2014","journal-title":"Neurology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"422","DOI":"10.4085\/1062-6050-49.2.09","article-title":"Fluoroquinolones and Tendinopathy: A Guide for Athletes and Sports Clinicians and a Systematic Review of the Literature","volume":"49","author":"Lewis","year":"2014","journal-title":"J. Athl. Train."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1007\/s40264-013-0089-8","article-title":"Tendon Injury and Fluoroquinolone Use: A Systematic Review","volume":"36","author":"Stephenson","year":"2013","journal-title":"Drug Saf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1017\/ice.2019.247","article-title":"Impact of FDA black box warning on fluoroquinolone and alternative antibiotic use in southeastern US hospitals","volume":"40","author":"Yarrington","year":"2019","journal-title":"Infect. Control. Hosp. Epidemiol."},{"key":"ref_9","unstructured":"(2021, August 25). Fluoroquinolone Safety Labeling Changes\u2014FDA\/CDER Drug Information Webinar, Available online: https:\/\/www.fda.gov\/media\/104060\/download."},{"key":"ref_10","unstructured":"(2021, August 25). Levaquin Citizen Petition. Available online: https:\/\/ewscripps.brightspotcdn.com\/e7\/36\/d5778eb841b882edc9277eafd700\/levaquin-citizens-petition.pdf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e103","DOI":"10.1093\/cid\/ciq257","article-title":"International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases","volume":"52","author":"Gupta","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1093\/cid\/ciy035","article-title":"Opportunities to Improve Fluoroquinolone Prescribing in the United States for Adult Ambulatory Care Visits","volume":"67","author":"Kabbani","year":"2018","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1053\/j.gastro.2016.02.032","article-title":"Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features, and Rome IV","volume":"150","author":"Drossman","year":"2016","journal-title":"Gastroenterology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1053\/j.gastro.2011.02.025","article-title":"Neurogastroenterology: A Great Career Choice for Aspiring Gastroenterologists Thinking About the Future","volume":"140","author":"Pasricha","year":"2011","journal-title":"Gastroenterology"},{"key":"ref_15","first-page":"G880","article-title":"Glutamatergic plasticity within neurocircuits of the dorsal vagal complex and the regulation of gastric functions","volume":"320","author":"Clyburn","year":"2021","journal-title":"Am. J. Physiol. Liver Physiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"106","DOI":"10.33590\/emjgastroenterol\/10314603","article-title":"The Versatile Role of The Vagus Nerve in The Gastrointestinal Tract","volume":"9","author":"Stakenborg","year":"2013","journal-title":"EMJ Gastroenterol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/0016-5085(93)90419-D","article-title":"The central organization of the vagus nerve innervating the colon of the rat","volume":"104","author":"Altschuler","year":"1993","journal-title":"Gastroenterology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1002\/cphy.c130055","article-title":"Central Nervous System Control of Gastrointestinal Motility and Secretion and Modulation of Gastrointestinal Functions","volume":"4","author":"Browning","year":"2014","journal-title":"Compr. Physiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1038\/nrgastro.2016.76","article-title":"Vagal neurocircuitry and its influence on gastric motility","volume":"13","author":"Travagli","year":"2016","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Fornai, M., Antonioli, L., Colucci, R., Tuccori, M., and Blandizzi, C. (2011). Pathophysiology of gastric ulcer development and healing: Molecular mechanisms and novel therapeutic options. Peptic Ulcer Disease, StatPearls Publishing LLC.","DOI":"10.5772\/17640"},{"key":"ref_21","first-page":"G531","article-title":"Glutamate and GABA-mediated synaptic currents in neurons of the rat dorsal motor nucleus of the vagus","volume":"260","author":"Travagli","year":"1991","journal-title":"Am. J. Physiol. Liver Physiol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Gillis, R.A., Dezfuli, G., Bellusci, L., Vicini, S., and Sahibzada, N. (2021). Brainstem Neuronal Circuitries Controlling Gastric Tonic and Phasic Contractions: A Review. Cell. Mol. Neurobiol., 1\u201328.","DOI":"10.1007\/s10571-021-01084-5"},{"key":"ref_23","first-page":"G101","article-title":"GABA signaling in the nucleus tractus solitarius sets the level of activity in dorsal motor nucleus of the vagus cholinergic neurons in the vagovagal circuit","volume":"296","author":"Herman","year":"2009","journal-title":"Am. J. Physiol. Liver Physiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1056\/NEJMc1212055","article-title":"U.S. Outpatient Antibiotic Prescribing","volume":"368","author":"Hicks","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1093\/jac\/33.4.685","article-title":"Structure-activity and structure-side-effect relationships for the quinolone antibacterials","volume":"33","author":"Domagala","year":"1994","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1038\/sj.bjp.0701411","article-title":"Selective antagonism of the GABAA receptor by ciprofloxacin and biphenylacetic acid","volume":"122","author":"Green","year":"1997","journal-title":"Br. J. Pharmacol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"374","DOI":"10.3109\/15376516.2015.1026008","article-title":"Ciprofloxacin-induced neurotoxicity: Evaluation of possible underlying mechanisms","volume":"25","author":"Ilgin","year":"2015","journal-title":"Toxicol. Mech. Methods"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1128\/AAC.38.6.1356","article-title":"Ciprofloxacin and sparfloxacin penetration into human brain tissue and their activity as antagonists of GABAA receptor of rat vagus nerve","volume":"38","author":"Davey","year":"1994","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1248\/cpb.44.1425","article-title":"Interaction of Quinolones with Metal Cations in Aqueous Solution","volume":"44","author":"Kawai","year":"1996","journal-title":"Chem. Pharm. Bull."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2017\/8023935","article-title":"Treatment of the Fluoroquinolone-Associated Disability: The Pathobiochemical Implications","volume":"2017","author":"Michalak","year":"2017","journal-title":"Oxidative Med. Cell. Longev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1515\/DMDI.2010.003","article-title":"Effect of metal ions on some pharmacologically relevant interactions involving fluoroquinolone antibiotics","volume":"25","author":"Seedher","year":"2010","journal-title":"Drug Metab. Drug Interact."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1023\/A:1012014608733","article-title":"Mechanistic Investigation of the Reduction in Antimicrobial Activity of Ciprofloxacin by Metal Cations","volume":"14","author":"Ma","year":"1997","journal-title":"Pharm. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1904","DOI":"10.1128\/AAC.31.12.1904","article-title":"High-Performance Liquid Chromatography Measurement of Antimicrobial Concentrations in Polymor-phonuclear Leukocytes","volume":"31","author":"Koga","year":"1987","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1128\/AAC.41.2.274","article-title":"Uptake and intracellular activity of trovafloxacin in human phagocytes and tissue-cultured epithelial cells","volume":"41","author":"Pascual","year":"1997","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Andriole, V.T. (2000). The Quinolones, Academic Press. [3rd ed.].","DOI":"10.1016\/B978-012059517-4\/50017-9"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1128\/AAC.41.2.427","article-title":"Effects of Some Excitatory Amino Acid Antagonists and Drugs En-hancing Gamma-Aminobutyric Acid Neurotransmission on Pefloxacin-Induced Seizures in DBA\/2 Mice","volume":"41","author":"Nava","year":"1997","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_37","first-page":"31","article-title":"The Effect of Ciprofloxacin Injection on Ge-netically Absence Prone (Wag\/Rij) Rat\u2019s Electroencephalogram Characteristics","volume":"4","author":"Moghimi","year":"2013","journal-title":"Basic Clin. Neurosci."},{"key":"ref_38","unstructured":"(2021, August 25). CIPRO (Ciprofloxacin Hydrochloride)\u2013FDA Label, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2016\/019537s086lbl.pdf."},{"key":"ref_39","unstructured":"(2021, August 25). LEVAQUIN\u00a9 (Levofloxacin)\u2014Label, Available online: https:\/\/www.fda.gov\/files\/drugs\/published\/Levaquin-Label.pdf."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1016\/S0025-6196(12)62169-7","article-title":"Assessment of Functional Gastrointestinal Disease: The Bowel Disease Questionnaire","volume":"65","author":"Talley","year":"1990","journal-title":"Mayo Clin. Proc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1146\/annurev-micro-091313-103456","article-title":"Effects of Antibiotics on Human Microbiota and Subsequent Disease","volume":"68","author":"Keeney","year":"2014","journal-title":"Annu. Rev. Microbiol."},{"key":"ref_42","unstructured":"(2021, October 01). AVELOX (Moxifloxacin Hydrochloride), Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2016\/021085s063lbl.pdf."},{"key":"ref_43","unstructured":"(2021, August 25). FLOXIN\u00a9 (Ofloxacin Tablets)\u2014Label, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2008\/019735s059lbl.pdf."},{"key":"ref_44","unstructured":"(2021, August 25). MAXAQUIN\u00a9 (Lomefloxacin Hydrochloride Tablets)\u2014Label, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2005\/20013s015lbl.pdf."},{"key":"ref_45","unstructured":"(2021, August 25). NOROXIN\u00a9 (Norfloxacin)\u2014Label, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2013\/019384s066lbl.pdf."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/2046-4053-1-39","article-title":"Effectiveness of rifaximin and fluoroquinolones in preventing travelers\u2019 diarrhea (TD): A systematic review and meta-analysis","volume":"1","author":"Alajbegovic","year":"2012","journal-title":"Syst. Rev."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/0016-5085(80)90142-0","article-title":"Functional bowel disorders in apparently healthy people","volume":"79","author":"Thompson","year":"1980","journal-title":"Gastroenterology"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1136\/bmj.2.6138.653","article-title":"Towards positive diagnosis of the irritable bowel","volume":"2","author":"Manning","year":"1978","journal-title":"BMJ"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1136\/gut.25.10.1089","article-title":"Gastrointestinal symptoms in the irritable bowel compared with peptic ulcer and inflammatory bowel disease","volume":"25","author":"Thompson","year":"1984","journal-title":"Gut"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0016-5085(84)90119-7","article-title":"A diagnostic score for the irritable bowel syndrome","volume":"87","author":"Kruis","year":"1984","journal-title":"Gastroenterology"},{"key":"ref_51","unstructured":"Muris, J., Starmans, R., Pop, P., Crebolder, H.F., and Knottnerus, J.A. (1994). Discriminant value of symptoms in patients with dyspepsia. J. Fam. Pract., 38."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1136\/gut.19.1.19","article-title":"Clinical presentation of patients with \"dyspepsia\". Detailed symptomatic study of 360 patients","volume":"19","author":"Horrocks","year":"1978","journal-title":"Gut"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/S0016-5085(82)80186-8","article-title":"Bowel patterns among subjects not seeking health care. Use of a questionnaire to identify a population with bowel dysfunction","volume":"83","author":"Drossman","year":"1982","journal-title":"Gastroenterology"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/0016-5085(84)90706-6","article-title":"Symptom complaints and health care seeking behavior in subjects with bowel dysfunction","volume":"87","author":"Sandler","year":"1984","journal-title":"Gastroenterology"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1053\/j.gastro.2005.04.020","article-title":"Functional GI Disorders: What\u2019s in a Name?","volume":"128","author":"Drossman","year":"2005","journal-title":"Gastroenterology"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1053\/j.gastro.2006.03.008","article-title":"The Functional Gastrointestinal Disorders and the Rome III Process","volume":"130","author":"Drossman","year":"2006","journal-title":"Gastroenterology"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e21","DOI":"10.1016\/j.ejim.2018.07.012","article-title":"Fluoroquinolone-associated suicide","volume":"55","author":"Kommalapati","year":"2018","journal-title":"Eur. J. Intern. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1080\/14740338.2019.1665022","article-title":"An evaluation of reports of ciprofloxacin, levofloxacin, and moxifloxacin-association neuropsychiatric toxicities, long-term disability, and aortic aneurysms\/dissections disseminated by the Food and Drug Administration and the European Medicines Agency","volume":"18","author":"Bennett","year":"2019","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"212","DOI":"10.4103\/0976-3147.98256","article-title":"Levofloxacin-induced acute anxiety and insomnia","volume":"3","author":"Kandasamy","year":"2012","journal-title":"J. Neurosci. Rural. Pract."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1176\/ajp.152.6.954b","article-title":"Fluoroquinolone-induced depression","volume":"152","author":"Feinberg","year":"1995","journal-title":"Am. J. Psychiatry"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1007\/s002040050008","article-title":"Ciprofloxacin causes cytoskeletal changes and detachment of human and rat chondrocytes in vitro","volume":"73","author":"Egerbacher","year":"2000","journal-title":"Arch. Toxicol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1177\/019262339602400507","article-title":"Comparative Evaluation of Ultrastructural Changes in Articular Cartilage of Ofioxacin-Treated and Magnesium-Deficient Immature Rats","volume":"24","author":"Shakibaei","year":"1996","journal-title":"Toxicol. Pathol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/S0171-9335(99)80081-8","article-title":"Integrins mediate the effects of quinolones and magnesium deficiency on cultured rat chondrocytes","volume":"78","author":"Egerbacher","year":"1999","journal-title":"Eur. J. Cell Biol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.cbi.2010.07.017","article-title":"Trovafloxacin, a fluoroquinolone antibiotic with hepatotoxic potential, causes mitochondrial peroxynitrite stress in a mouse model of underlying mitochondrial dysfunction","volume":"188","author":"Hsiao","year":"2010","journal-title":"Chem. Interact."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1124\/jpet.103.057984","article-title":"In Vitro Discrimination of Fluoroquinolones Toxicity on Tendon Cells: Involvement of Oxidative Stress","volume":"308","author":"Pouzaud","year":"2003","journal-title":"J. Pharmacol. Exp. Ther."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.jhazmat.2013.03.006","article-title":"Oxidative stress response of two fluoroquinolones with catalase and erythrocytes: A combined molecular and cellular study","volume":"252\u2013253","author":"Qin","year":"2013","journal-title":"J. Hazard. Mater."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"304","DOI":"10.4103\/0975-1483.90242","article-title":"Oxidative Stress Induced by Fluoroquinolones on Treatment for Complicated Urinary Tract Infections in Indian Patients","volume":"3","author":"Talla","year":"2011","journal-title":"J. Young-Pharm."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1177\/0960327114530743","article-title":"Evaluation of gatifloxacin for its potential to induce antioxidant imbalance and retinopathy in rabbits","volume":"34","author":"Kumbhar","year":"2014","journal-title":"Hum. Exp. Toxicol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"54","DOI":"10.12788\/jcso.0167","article-title":"Fluoroquinolone-related neuropsychiatric and mitochondrial toxicity: A collaborative investigation by scientists and members of a social network","volume":"14","author":"Kaur","year":"2016","journal-title":"J. Community Support. Oncol."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Karakan, T., Ozkul, C., Akkol, E.K., Bilici, S., Sobarzo-S\u00e1nchez, E., and Capasso, R. (2021). Gut-Brain-Microbiota Axis: Antibiotics and Functional Gastrointestinal Disorders. Nutrients, 13.","DOI":"10.3390\/nu13020389"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1016\/S0140-6736(20)32115-2","article-title":"Functional gastrointestinal disorders: Advances in understanding and management","volume":"396","author":"Black","year":"2020","journal-title":"Lancet"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0378-1135(93)90144-V","article-title":"The effect of antimicrobial agents on the ecology of the human intestinal microflora","volume":"35","author":"Nord","year":"1993","journal-title":"Veter. Microbiol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"4554","DOI":"10.1073\/pnas.1000087107","article-title":"Incomplete recovery and individualized responses of the human distal gut microbiota to repeated antibiotic perturbation","volume":"108","author":"Dethlefsen","year":"2010","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S0167-7012(03)00059-9","article-title":"Use of denaturing gradient gel electrophoresis for analysis of the stool microbiota of hospitalized patients","volume":"54","author":"Donskey","year":"2003","journal-title":"J. Microbiol. Methods"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1128\/CMR.00007-10","article-title":"Penetration of Drugs through the Blood-Cerebrospinal Fluid\/Blood-Brain Barrier for Treatment of Central Nervous System Infections","volume":"23","author":"Nau","year":"2010","journal-title":"Clin. Microbiol. Rev."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/12\/1371\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:50:13Z","timestamp":1760169013000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/12\/1371"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,16]]},"references-count":75,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["medicina57121371"],"URL":"https:\/\/doi.org\/10.3390\/medicina57121371","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,16]]}}}