Antimicrobial drug treatments associated with neuropathy and other pain conditions192–194
| Drug treatment | Common indications | Associated pain conditions | Comments |
| Antibiotics | |||
| Chloramphenicol | Superficial eye and ear infections, typhoid, cholera, meningitis | Peripheral neuropathy, bowel inflammation | Broad spectrum antibiotics are rarely used in Europe and North America owing to the potential for aplastic anemia, and designation by the World Health Organization as a probable human carcinogen. |
| Chloroquine and hydroxychloroquine | Malaria, amoebiasis, rheumatic diseases | Peripheral neuropathy, myopathy | Chronic pain conditions are associated with long term use for rheumatic conditions. |
| Clioquinol | Fungus and protozoan infections; sometimes mixed with other agents for inflammatory skin conditions | Peripheral neuropathy and spinal cord demyelination | Development of subacute myelo-optic neuropathy led to ban in many countries. Resurgence in study for cancer and neurodegenerative disorders. |
| Dapsone | Leprosy, Pneumocystis prophylaxis, dermatitis herpetiformis | Peripheral neuropathy, internal organ inflammation (nephritis, interstitial pneumonitis, hepatitis) | Common alternative to trimethoprim-sulfamethoxazole for Pneumocystis prophylaxis in immunocompromised patients. |
| Ethambutol | Tuberculosis and non-tuberculous mycobacterial infections | Peripheral and optic neuropathy, worsening gout or joint pain, hepatitis | Used in combination with other drugs to treat tuberculosis and non-tuberculous mycobacterial infections, often for many months. |
| Fluoroquinolones | Broad spectrum, effective against many bacteria, including tuberculosis and non-tuberculous mycobacterial infections | Peripheral neuropathy, tendinopathy, myopathy and arthropathy, hepatitis | Associated with four black box warnings (tendon rupture or tendonitis, peripheral neuropathy, effects in the central nervous system, exacerbation of myasthenia gravis). |
| Griseofulvin | Ringworm (tinea) infections including athlete’s foot (tinea pedis) | Peripheral neuropathy, myopathy and arthropathy, hepatitis | Treatment duration could last from weeks to months, usually after topical treatments have failed. |
| Isoniazid | Tuberculosis (active and latent) and non-tuberculous mycobacterial infections | Peripheral neuropathy, myopathy, hepatitis, lupus-like syndrome with polyarthralgia and erythematosus | Used in tandem with other anti-tuberculosis drugs, often for many months. Neuropathy could be prevented by co-treatment with pyridoxine. |
| Linezolid | Gram positive bacteria, multidrug-resistant tuberculosis and non-tuberculous mycobacterial infections | Peripheral and optic neuropathy, diffuse body aches, hepatitis, and abdominal pain | Prolonged courses generally needed for tuberculosis and non-tuberculous mycobacterial infections. Incidence of neuropathy might be reduced by once daily dosing. |
| Metronidazole | Anaerobic bacteria, parasitic infections such as amoebiasis and trichomonas | Peripheral neuropathy, oral ulcers or stomatitis, cystitis, dysuria and pelvic pain, proctitis | Often used for sexually transmitted diseases and after colorectal surgery. |
| Nitrofurantoin | Broad spectrum, commonly used in urinary tract infections | Peripheral and optic neuropathy, interstitial pneumonitis, hepatitis | Side effects are less common because the drug concentrates in urine; drug resistance is uncommon. |
| Suramin | Antiparasitic used to treat trypanosomiasis (African sleeping sickness) and onchocerciasis (river blindness) | Peripheral neuropathy, arthralgia (suramin also inhibits osteoarthritic cartilage degradation) | Has demonstrated efficacy for hormone refractory prostate cancer and autism; introduced 100 years ago in 1922. |
| Antiviral drug treatments | |||
| Zalcitabine | HIV | Peripheral neuropathy, hepatitis, pancreatitis, stomatitis, myopathy | Neuropathy from nucleoside reverse transcriptase inhibitors might be exacerbated by alcohol use, metabolic impairments, co-treatment with other nucleoside reverse transcriptase inhibitors, and low CD4 counts. Incidence ranges from 30% to >75%. Rarely used in developed countries. |
| Didanosine | HIV | Peripheral neuropathy including optic neuritis, myopathy, pancreatitis and other gastrointestinal symptoms (eg, hepatitis) | Co-treatment with stavudine should be done with caution owing to high risk of side effects. Side effects are dose related and usually reversible. Treatment course could last for years. Rarely used in developed countries |
| Stavudine | HIV | Peripheral neuropathy, pancreatitis, lactic acidosis | Treatment course could last for years. Side effects are dose related and usually reversible. Rarely used in developed countries |
| Zidovudine | HIV and prevention of perinatal HIV transmission | Myopathy, headache, hepatitis | Treatment course could last for years. Side effects are dose related and usually reversible. Rarely used in developed countries |
| Nevirapine | HIV | Hepatitis, peripheral neuropathy, gastrointestinal symptoms | Non-nucleoside reverse transcriptase inhibitor. Elevated liver enzymes much more common than hepatitis. Increased risk of hepatitis in individuals with infectious hepatitis. |
| Etravirine | HIV | Hepatitis, peripheral neuropathy, gastrointestinal symptoms including pancreatitis, toxic epidermal necrolysis | Non-nucleoside reverse transcriptase inhibitor. Treatment course could last for years. Incidence difficult to pinpoint in clinical trials evaluating multiple concurrent drug treatments. |
| Lamivudine | HIV and hepatitis B | Peripheral neuropathy, pancreatitis, myopathy | Peripheral neuropathy is generally mild, usually with other nucleoside reverse transcriptase inhibitors during long term treatment. |
| Fialuridine | Hepatitis B (not currently in use) | Peripheral neuropathy, myopathy | 1993 clinical trial at the US National Institutes of Health halted because over one-third of patients developed liver failure. |