Quinolones

Go to algorithm

exp date isn't null, but text field is

MHRA alert: fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects (March 2019) (www.gov.uk)

MHRA/CHM advice: Systemic and inhaled fluoroquinolones.  The MHRA and CHM have released important safety information regarding the use of systemic and inhaled fluoroquinolones. For restrictions and precautions, see important safety information for all quinolones: ciprofloxacin, delafloxacin, levofloxacin, moxifloxacin, and ofloxacin.

CSM advice: tendon damage (including rupture) has been reported rarely in patients receiving quinolones. Tendon rupture may occur within 48 hours of starting treatment. The CSM note that:

  • quinolones are contra-indicated in patients with a history of tendon disorders related to quinolone use
  • older patients are more prone to tendon damage
  • the risk of tendon rupture is increased by the concomitant use of corticosteroids
  • if tendinitis is suspected, discontinue quinolone immediately.

Use with caution as high risk of infection with Clostridioides difficile; change to an alternative agent where possible, according to Microbiology results.

CIPROFLOXACIN

Therapy notes

MHRA alert: Systemic and inhaled fluoroquinolones: small risk of heart valve regurgitation; consider other therapeutic options first in patients at risk (December 2020) (www.gov.uk).
MHRA alert: Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects (March 2019) (www.gov.uk).

  • Ciprofloxacin has unreliable activity against Streptococcus pneumoniae and is unsuitable for the initial treatment of community-acquired pneumonia.  Refer to NHS Highland and Western Isles Antimicrobial website for more appropriate treatment.

Formulation

Tablets 250mg, 500mg, 750mg

Formulation

Oral suspension 250mg/5mL

Formulation

Infusion 200mg/100mL, 400mg/200mL

LEVOFLOXACIN

Therapy notes

MHRA alert: Systemic and inhaled fluoroquinolones: small risk of heart valve regurgitation; consider other therapeutic options first in patients at risk (December 2020) (www.gov.uk).
MHRA alert: Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects (March 2019) (www.gov.uk).

  • Levofloxacin has increased activity against Streptococcus pneumoniae therefore is a suitable alternative in the management of respiratory infections in patients with an allergy to penicillin. 
  • It is the drug of choice in the treatment of known or suspected Legionella infection.

Formulation

Tablets 250mg, 500mg

Formulation

Infusion 500mg in 100mL

OFLOXACIN

Therapy notes

MHRA alert: Systemic and inhaled fluoroquinolones: small risk of heart valve regurgitation; consider other therapeutic options first in patients at risk (December 2020) (www.gov.uk).
MHRA alert: Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects (March 2019) (www.gov.uk).

Formulation

Tablets 200mg, 400mg

Formulation

Infusion 200mg/100mL