Quinolones (Formulary)

Important: Therapy notes

MHRA advice: Flouroquinolone antibiotics: must now only be prescribed when other commonly recommended antibiotics are inappropriate.  Updated safety advice is available here including a patient information leaflet.  Side effects may be disabling, long-lasting and sometimes irreversible.  Systems affected include musculoskeletal (tendonitis/rupture), neurological (muscle weakness), sensory (peripheral neuropathy) and psychiatric (tiredness, anxiety, depression and suicidal thoughts).  Fluoroquinolones should not be prescribed for self-limiting or mild to moderate infections or non-bacterial (chronic) prostatitis (January 2024).
MHRA advice: Fluoroquinolone antibiotics: suicidal thoughts and behaviour (September 2023) (www.gov.uk).  
MHRA advice: Fluoroquinolone antibiotics: reminder of the risk of disabling and potentially long-lasting or irreversible side effects (August 2023) (www.gov.uk).  
MHRA advice: 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 advice: 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.

Important: Therapy notes

MHRA advice: Flouroquinolone antibiotics: must now only be prescribed when other commonly recommended antibiotics are inappropriate.  Updated safety advice is available here including a patient information leaflet.  Side effects may be disabling, long-lasting and sometimes irreversible.  Systems affected include musculoskeletal (tendonitis/rupture), neurological (muscle weakness), sensory (peripheral neuropathy) and psychiatric (tiredness, anxiety, depression and suicidal thoughts).  Fluoroquinolones should not be prescribed for self-limiting or mild to moderate infections or non-bacterial (chronic) prostatitis (January 2024).
MHRA advice: Fluoroquinolone antibiotics: suicidal thoughts and behaviour (September 2023) (www.gov.uk).  
MHRA advice: Fluoroquinolone antibiotics: reminder of the risk of disabling and potentially long-lasting or irreversible side effects (August 2023) (www.gov.uk).  
MHRA advice: 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 advice: 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.

Important: Therapy notes

MHRA advice: Flouroquinolone antibiotics: must now only be prescribed when other commonly recommended antibiotics are inappropriate.  Updated safety advice is available here including a patient information leaflet.  Side effects may be disabling, long-lasting and sometimes irreversible.  Systems affected include musculoskeletal (tendonitis/rupture), neurological (muscle weakness), sensory (peripheral neuropathy) and psychiatric (tiredness, anxiety, depression and suicidal thoughts).  Fluoroquinolones should not be prescribed for self-limiting or mild to moderate infections or non-bacterial (chronic) prostatitis (January 2024).
MHRA advice: Fluoroquinolone antibiotics: suicidal thoughts and behaviour (September 2023) (www.gov.uk).  
MHRA advice: Fluoroquinolone antibiotics: reminder of the risk of disabling and potentially long-lasting or irreversible side effects (August 2023) (www.gov.uk).  
MHRA advice: 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 advice: 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).