Fluoroquinolone antibiotics and adverse events

Abstract

Fluoroquinolones are broad-spectrum antibiotics with good oral bioavailability. They are used for the treatment of a wide variety of infections, but there are restrictions on prescribing these drugs.Epidemiological studies have reported an increased risk of rare adverse effects. These include tendinopathy and tendon rupture, peripheral neuropathy and aortic aneurysm.Safe prescribing of fluroquinolones requires recognition of patients with risk factors for toxicity. Prompt drug discontinuation is recommended in the event of an adverse reaction.Practising antimicrobial stewardship by prescribing fluoroquinolones only when alternative drugs are unavailable is also key to limiting adverse events and antibiotic resistance.Risk factors for fluoroquinolone-associated tendinopathy are incompletely defined. Most studies report a pooled incidence from a range of fluoroquinolones including those currently unavailable within Australia. 3,7 Older age and concomitant corticosteroid use are identified as risk factors. Corticosteroids are associated with up to a 14-fold Diva BaggioAdvanced trainee 1 Michelle R Ananda-Rajah Infectious diseases and general medicine physician 2,3

A preventable, life-altering case of fluoroquinolone-associated tendonitis

“…This drug class, which includes ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin, and delafloxacin, directly inhibits bacterial DNA synthesis 1. Although fluoroquinolones became popular in large part because of their excellent oral bioavailability, because of their serious adverse reaction profile, they should only be used if other therapeutic options have been exhausted 2. In 2016, 2017, and 2018, the FDA issued drug safety communications that advised restricting fluoroquinolone use in patients with acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, and uncomplicated UTIs, given the risk of serious adverse reactions 3.…”

Prostate Cancer Diagnosis: Biopsy Approaches

“…This has been shown to reduce infectious complications compared to single agent prophylaxis with the majority of studies included within the metanalysis using fluoroquinolone as one of the agents, often in conjunction with an aminoglycoside (161). Recently, there has been concern with regards to increasing recognized adverse effects of fluoroquinolone antibiotics and their use in perioperative prophylaxis has been restricted in some regions (169,170). As a result, there has been an increased emphasis on alternative antibiotics for prophylaxis.…”

Long-Term Intensive Care Unit (ICU) Stays Can Lead to Long-Term Cognitive Impairment (LTCI): Neurosurgery Nursing Strategies to Minimize Risk

“…Patients that were given quinolones and vancomycin had a strong association with developing post-ICU LTCI [ 16 ]. Fluoroquinolone can cause CNS side effects including psychosis, hallucinations, and convulsions, and it is postulated that these neurologic deficits are what may predispose patients to LTCI [ 20 ].…”