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Fluoroquinolones: use should be restricted due to severe adverse effects

Given the many and sometimes severe adverse effects of fluoroquinolone antibiotics, they should only be used for limited purposes.

Fluoroquinolones are a group of antibiotics that are effective on many bacteria. But their adverse effects are many and sometimes severe, which has led to the gradual limitation of their use.

The European Pharmacovigilance Committee (PRAC) reassessed all adverse reactions to fluoroquinolones in 2018 and recommended that fluoroquinolones should only be prescribed as a last resort in simple acute cystitis, acute exacerbations of chronic obstructive pulmonary disease, acute bacterial sinusitis, and acute otitis media; they are no longer authorised in infections where their benefit is marginal (e. g. pharyngitis, acute bronchitis, septicemia, prevention of urinary infections).

Fluoroquinolones should be restricted to a range of other situations, such as complicated urinary tract infections, genital or gynaecological infections and some lung infections. The PRAC also recommended to suspend marketing authorisations for so-called first-generation quinolones, considering that their effectiveness is too minimal given the adverse effects reported.

Furthermore, a review of clinical trials and epidemiological studies has shown that fluoroquinolones in general, and moxifloxacin in particular, increase cardiovascular mortality. 

©Prescrire 1 September 2019

"Fluoroquinolones: the need for increasingly targeted use" Prescrire Int 2019; 28 (207): 212-213. (Pdf, subscribers only).

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See also:

Fluoroquinolones:
cardiovascular deaths
Prescrire Int 2019:
28 (207): 214.
Pdf, subscribers only

Fluoroquinolones: aortic
aneurysm and dissection
Prescrire Int 2018;
27 (199): 297.
Pdf, subscribers only

Drug-induced
tendon damage
Prescrire Int 2016;
25 (174): 212-213.   
Pdf, subscribers only

Fluoroquinolones and
tendon disorders: even
after single-dose therapy
Prescrire Int 2012;
21 (129): 185. 
Pdf, subscribers only