Part III: Guidelines for Selected Antimicrobial Use

3.14 Fluoroquinolones

Ciprofloxacin, levofloxacin, and moxifloxacin are some common examples of fluoroquinolones (FQs) for systemic use.
A number of health authorities have issued safety updates or warnings regarding the systemic use of FQs. [281–293]
The following is a non-exhaustive list of possible serious side effects that have been suggested to be associated with FQs:

Neuropsychiatric

Psychiatric reactions including depression, psychotic reactions which may potentially lead to suicidal thoughts and attempts. [293]

Central nervous system toxicity: gait disturbance, memory impairment, sleep disorders [290,292]

Peripheral neuropathy [288]

Pseudotumour cerebri [294]

Exacerbation of myasthenia gravis [295]

Cardiovascular

Aortic aneurysm or dissection [281,285,296,297]

Prolonged QT interval, arrhythmia or death [298,299]

Musculoskeletal

Tendinitis, tendon injury or tendon rupture especially in people older than 60 years, people on corticosteroid, people with renal impairment or solid-organ transplants. [290]

Blood glucose disturbances [285]

Drug-drug interactions

Clinicians should weigh risk and benefits when prescribing FQs:

For patients with acute sinusitis, acute bronchitis, and uncomplicated urinary tract infections, FQs should be reserved for those who do not have alternative treatment options. [283]

Consider past history, such as previous exposure and tolerance. Avoid FQs in patients who have previously had serious adverse reactions with a quinolone antibiotic (for example, nalidixic acid) or a FQ. [290]

Patients should be advised to stop FQs at the first signs of a serious adverse reaction, e.g. tendinitis or tendon rupture, muscle pain, muscle weakness, joint pain, joint swelling, peripheral neuropathy and central nervous system effects, and to contact their doctor immediately. [286,290,292]