Fluoroquinolone antibiotics – Safety Concerns

Fluoroquinolone antibiotics, such as ciprofloxacin, have a limited place in NICE & Public Health England guidance on managing common infections.

Fluoroquinolones may be first line options for treatment of acute prostatitis, epidydimitis,  gonorrhoea & acute pyelonephritis, and second choice options for LRTI, catheter associated LUTI and pelvic inflammatory disease – depending on bacterial susceptibilities and taking account of safety issues.

The MHRA have updated, revised and strengthened advice on important safety issues:

• small increased risk of aortic aneurysm & dissection
• reports of disabling and potentially long-lasting, irreversible side effects mainly affecting the musculoskeletal and nervous systems

MHRA ADVICE

• fluoroquinolones can very rarely cause long-lasting, disabling, and potentially irreversible side effects, sometimes affecting multiple systems, organ classes, and senses – and may be associated with an increased risk of aortic aneurysm and dissection, particularly in older patients
• DO NOT PRESCRIBE:
  • for patients who have previously had serious adverse reactions
  • for use with corticosteroids – as co-administration could exacerbate tendinitis or tendon rupture
  • for non-severe or self-limiting infections, or non-bacterial conditions
  • for some mild to moderate infections or uncomplicated cystitis unless other recommended antibiotics are not inappropriate
• ONLY PRESCRIBE WITH SPECIAL CAUTION for people >60 years, those with renal impairment or solid-organ transplants and only for patients at risk for aortic aneurysm/dissection^# after careful benefit-risk assessment and consideration of other options
• ADVISE PATIENTS about aortic aneurysm/dissection and to seek immediate medical attention in case of sudden-onset severe abdominal, chest or back pain
• ADVISE PATIENTS to stop treatment at the first signs of other serious adverse reaction – such as tendinitis, tendon rupture, muscle pain, muscle weakness, joint pain, joint swelling, peripheral neuropathy, or CNS effects, and to contact their doctor immediately for further advice

^#Conditions predisposing to aortic aneurysm and dissection include: a family history of aneurysm disease; diagnosis with pre-existing aortic aneurysm and/or aortic dissection; conditions predisposing for aortic aneurysm and dissection (e.g. Marfan syndrome, vascular Ehlers-Danlos syndrome, Takayasu arteritis, giant cell arteritis, Behcet’s disease, hypertension, and known atherosclerosis).