In light of the recent MHRA restrictions on the use of fluoroquinolone antibiotics, this article provides an overview of the adverse reactions associated with all classes of antibiotic ‐ from the most common side‐effects such as gastrointestinal disturbance to rare, idiosyncratic reactions.

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In Scotland, where Lyme borreliosis is notifiable, transmission is well recognised across the country with an incidence is 5.9 per 100 000 nationally, increasing to 43 per 100 000 in the Highlands. 4 Clinical manifestationsThe clinical manifestations of Lyme borreliosis are multiple and the natural histor y varied, but an understanding of the pathogenesis allows the disease to be viewed in three stages. In the first stage there is multiplication and local invasion of Borrelia spp. at the site of inoculation. In some people this is asymptomatic, while in others it causes erythema migrans, systemic symptoms (myalgia, headache, arthralgia, fatigue) or both.In the second stage there is dissemination and seeding of distant tissue manifesting commonly as nervous system disease or rarely as carditis. These early features of disseminated disease often overlap temporally with the local manifestations and these two stages have been termed 'early Lyme borreliosis'. As early Lyme borreliosis may manifest before seroconversion, negative acute serology does not rule out the diagnosis (see Table 1).The third stage, often termed 'late Lyme borreliosis', comprises later manifestations of dissemination occurring more than six months after infection, including arthritis, skin involvement and very rarely eye and late nervous system disease. It is fear of these late manifestations that is often of most con-50 Prescriber 5 March 2011 www.prescriber.co.uk antibody production synovial fluid or 95% in >99% (clean on discussion with reference laboratory biopsy for PCR previously lab) only untreated * These sensitivities and specificities were provided by Dr S O'Connel (HPA Lyme Diseases Reference Laboratory, Southampton) and are correct for that laboratory; the figures should not be used to interpret tests from unregulated laboratories. Sensitivity varies with duration of infection and infecting organism, with Borrelia burgdorferi sensu strictu triggering a more brisk response than Borrelia afzelii. PCR = polymerase chain reaction Prescribing in practice