5.1.12 Quinolones

Due to the risk of healthcare associated infection (including those due to MRSA and Clostridium difficile) quinolone use should be avoided unless there is a clear indication for their use. They should only be prescribed in accordance with guidelines. The shortest effective duration should be prescribed.

MHRA Drug Safety Update (November 2018): Systemic and inhaled fluoroquinolones:

  • systemic (by mouth or injection) and inhaled fluoroquinolones may be associated with a small increased risk of aortic aneurysm and dissection, particularly in older patients
  • fluoroquinolones should only be used after careful benefit-risk assessment and after consideration of other therapeutic options in patients at risk for aortic aneurysm and dissection
  • Conditions predisposing to aortic aneurysm and dissection include:
    • family history of aneurysm disease
    • diagnosis with pre-existing aortic aneurysm and/or aortic dissection
    • other risk factors or conditions predisposing for aortic aneurysm and dissection (for example, Marfan syndrome, vascular Ehlers-Danlos syndrome, Takayasu arteritis, giant cell arteritis, Behcet's disease, hypertension, and known atherosclerosis)
  • advise patients, particularly elderly people and those at risk, about rare events of aortic aneurysm and dissection and of the importance of seeking immediate medical attention in case of sudden-onset severe abdominal, chest or back pain

MHRA Drug Safety Update (March 2019): Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects

  • Systemic (by mouth, injection, or inhalation) fluoroquinolones can very rarely cause long-lasting (up to months or years), disabling, and potentially irreversible side effects, sometimes affecting multiple systems, organ classes, and senses
  • Advise patients to stop treatment at the first signs of a serious adverse reaction, such as 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 for further advice
  • Do not prescribe fluoroquinolones:
    • for non-severe or self-limiting infections, or non-bacterial conditions
    • for some mild to moderate infections (such as in acute exacerbation of chronic bronchitis and chronic obstructive pulmonary disease) unless other antibiotics that are commonly recommended for these infections are considered inappropriate
    • ciprofloxacin or levofloxacin should no longer be prescribed for uncomplicated cystitis unless other antibiotics that are commonly recommended are considered inappropriate
  • Avoid use in patients who have previously had serious adverse reactions with a quinolone or fluoroquinolone antibiotic
  • Prescribe with special caution for people older than 60 years and for those with renal impairment or solid-organ transplants because they are at a higher risk of tendon injury
  • Avoid use of a corticosteroid with a fluoroquinolone since coadministration could exacerbate fluoroquinolone-induced tendinitis and tendon rupture
Ciprofloxacin
  • Tablets 250mg, 500mg (£0.81, £1.03 = 10 tablets)
  • Oral suspension 250mg/5ml (£21.29 = 100ml)
  • Intravenous infusion 100mg/50ml, 200mg/100ml, 400mg/200ml

Indications

Notes

  1. Ciprofloxacin increases plasma theophylline levels.
  2. Ciprofloxacin has only a limited license for use in children.
  3. At appropriate doses oral ciprofloxacin is extremely well absorbed and blood levels are obtained which are comparable to those obtained by intravenous administration. Patients should be transferred to oral therapy at the earliest opportunity.
Levofloxacin
  • Tablets 250mg, 500mg (£10.36, £24.03 = 10 tablets)
  • Intravenous infusion 500mg/100ml

Indications

Ofloxacin
  • Tablets 200mg, 400mg (£7.79, £13.44 = 10 pack)

Indications

Moxifloxacin
  • Tablets 400mg
  • Infusion 400mg/250ml

 

Home > Formulary > Chapters > 5. Infections > 5.1 Antibacterial drugs > 5.1.12 Quinolones

 

  • First line
  • Second line
  • Specialist
  • Hospital