Fluoroquinolone warning

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The Medicines and Healthcare Regulatory Agency (MHRA) issued advice on restriction of fluoroquinolones following reviews of potentially disabling and long lasting adverse effects. The Fluoroquinolones available in the UK are:

  • ciprofloxacin
  • ofloxacin
  • levofloxacin
  • moxifloxacin
In NHS Lothian these antibiotics are WATCH antibiotics and prescribing is restricted. These drugs should only be used where recommended in approved guidelines or on the advice of an infection specialist. The MHRA warning includes this paragraph.
Precautions for prescribing fluoroquinolones, including for patients at increased risk.

Patients who are older than 60 years, have renal impairment, or have had solid-organ transplantation, and those being treated with a corticosteroid are at higher risk of tendon damage. Concomitant treatment with a fluoroquinolone and a corticosteroid should be avoided as the risk of fluoroquinolone-induced tendinitis and tendon rupture may be exacerbated.

Prescribers should take account of all cautions, contraindications and interactions as well as the patient’s medical history and reports of previous adverse drug reactions. Patients should be given advice about potential serious adverse drug reactions, and to stop treatment and seek advice at the first sign of any side effects involving musculoskeletal, cardiac or nervous systems. The MHRA states a Patient Information Leaflet should be given to patients.