Did You Know?

The U.S. Food and Drug Administration (FDA) has issued several warnings regarding fluoroquinolone (FQ) use. FQs include Levaquin (levofloxacin), Cipro (ciprofloxacin), Avelox (moxifloxacin), and Baxdela (delafloxacin). There are serious side effects associated with this class of antibiotics. When used systemically (IV or PO), disabling and potentially permanent adverse drug reactions can occur. Side effects include but are not limited to, joint, tendon, muscle, and nerve damage. CNS toxicity has been reported and varies from mild, such as lightheadedness, to moderate such as confusion, to severe, such as seizures or even psychosis. Pseudotumor cerebri is a potential side effect. Aortic dissection and rupture are associated with use in patients who have predisposing conditions. Hypoglycemia and hyperglycemia in both diabetic and nondiabetic patients is also a possible side effect. False-positive opiate screen may occur with FQs. QTc prolongation may occur. GI distress is possible as well as risk for C. difficile colitis. Thrombocytopenia has also been reported. Lastly, FQs may exacerbate myasthenia gravis.

What We Can Do?

The FDA has announced that FQs should no longer be used as first line treatment for the following infections:

• Acute sinusitis

• Acute bronchitis

• Uncomplicated urinary tract infections

In the above clinical scenarios, FQs should only be used as an alternative therapy. Due to high risk of adverse reaction, consider avoiding FQs if possible, and reserving this antibiotic only when truly necessary. Other infections to consider other antibiotics prior to use of FQs:

• Community acquired pneumonia

• Mild diverticulitis

“Progress is impossible without change, and those who cannot change their minds cannot change anything.”

˗ George Bernard Shaw