Fluoroquinolones can worsen neuromuscular transmission and have precipitated myasthenic crisis; regulators, including the FDA, carry a boxed warning against their use in people with myasthenia. Aminoglycosides, macrolides and magnesium can do the same.
When a person with myasthenia needs an antibiotic, choose another class where possible. If a fluoroquinolone is unavoidable, warn the patient and watch closely for new weakness, bulbar symptoms or breathlessness.
- Choose a non-fluoroquinolone antibiotic for people with myasthenia gravis where possible
- Aminoglycosides, macrolides and intravenous magnesium can also worsen weakness
- Warn patients to report new swallowing, speech or breathing difficulty
- Flag myasthenia prominently in the record so other prescribers see it
Why it matters
A routine antibiotic can tip stable myasthenia into crisis.
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