Fluoroquinolone antibiotics - MHRA Drug Safety Update Jan 2024

Please be aware of the latest MHRA Drug Safety update published 22nd January 2024. 

Full details available here - Fluoroquinolone antibiotics: must now only be prescribed when other commonly recommended antibiotics are inappropriate - GOV.UK (www.gov.uk)

Fluoroquinolone antibiotics = Ciprofloxacin, Levofloxacin, Moxifloxacin, Ofloxacin, Delafloxacin

Scottish Antimicrobial Prescribing Group (SAPG) statement:

MHRA (Medicines and Healthcare products Regulatory Agency) have issued updated advice recommending further restrictions on the use of systemic fluoroquinolones.

Due to concerns regarding potential disabling and long-lasting or irreversible side effects they are now restricted to the following individual patient scenarios:

• resistance to other first-line antibiotics recommended for the infection
• other first-line antibiotics are contraindicated in an individual patient
• other first-line antibiotics have caused side effects in the patient requiring treatment to be stopped
• treatment with other first-line antibiotics has failed

SAPG supports the restrictive use of fluoroquinolones in NHS Scotland and recommends that Antimicrobial Management Team (AMTs) within health boards review local guidance in view of the MHRA advice.

SAPG also recognises the potential for unintended consequences that may arise because of the MHRA advice.

Fluoroquinolones have an important position in many infection management guidelines in Scottish health boards as alternatives to beta lactams in true penicillin allergy.

Fluoroquinolones are also frequently the only available oral agent for some resistant Gram-negative infections.

The MHRA advice may inadvertently promote the selection of broader spectrum and intravenous (IV) alternatives to fluoroquinolones, or delay or prevent IV to oral switch. This may lead to prolonged hospital stay, increased use of IV devices and the use of broader spectrum agents with associated risks including vascular device related infections, antimicrobial resistance and increased treatment costs.

Where fluoroquinolone antibiotics are recommended in NHS FV antimicrobial guidelines, they are done so in-line with the MHRA drug safety update (e.g. accounting for beta lactam hypersensitivity) or are recommended in-line with national guidance or expert consensus. The drug safety update and patient information sheet should still be considered on case-by-case basis.