Prescribing fluoroquinolone: from revolutionary to restricted

Providing wide coverage against gram-positive and gram-negative organisms, fluoroquinolones are a class of broad-spectrum antibiotics that are credited with having revolutionised healthcare when they were first introduced in the late 1980s.

After serving as first-line treatment for decades for various infections, such as those of the respiratory and urinary tracts, their use has been restricted in recent years, with the newest update in January 2024, owing to rare but very serious long-lasting, sometimes permanent, disabling side effects from their use.

However, despite this, fluoroquinolones are still heavily prescribed, with nearly 38 000 systemic fluoroquinolones still being prescribed by GPs across England (as of November 2023) (Lipanovic, 2024). This article will delve into the use, side effects, regularly restrictions and future of fluoroquinolone prescribing.

In the UK, there are currently five fluoroquinolones licensed for use, which can be taken orally, given intravenously or via inhalation. These include the most common, ciprofloxacin, which is used to treat gram-negative infections, as well as delafloxacin, ofloxacin, and newer-generation agents, levofloxacin and moxifloxacin, which are effective against gram-positive bacteria (Lipanovic, 2024). They exhibit their antimicrobial activity via the inhibition of type II and type IV topoisomerase, which are needed in the replication, transcription, repair and recombination of DNA.