Safety Review: Fluoroquinolone
Fluoroquinolones have been enormously popular and successful antibiotics, thanks to their broad antimicrobial spectra, convenient dosing and tissue penetration. The most recent CDC data reported nearly 30 million outpatient prescriptions for fluoroquinolones in 2016. The wide use of these antibiotics has exposed diverse, severe toxicities, with some members of the class being withdrawn from the market. The remaining products have had several additions to the Boxed Warning and safety information sections of the labeling.
In December 2018, the FDA reported a newly observed increase in the risk of aortic aneurysm or dissection in patients taking fluoroquinolones. Other significant safety concerns include:
Hypoglycemia, including life-threatening events
Mental health effects, such as memory loss, disorientation, agitation and delirium
Tendinitis and tendon rupture
Worsening of myasthenia gravis
Severe side effects may occur in combination and may persist for months or years after discontinuation of the antibiotic. In May 2016, the FDA recommended that fluoroquinolones be reserved for use in patients who have no other treatment options. In particular, the FDA advised that fluoroquinolones not be used in patients with acute sinusitis, acute bronchitis, and uncomplicated UTIs if other options exist.
While the number of outpatient fluoroquinolone prescriptions has declined slightly, the number is still high. Millions of patients continue to be exposed to these known toxicities and those that may yet be identified. healthfinch reports confirm that several thousand systemic fluoroquinolone prescription refills were requested in the past year across their customer base.
Refill requests for all antibiotics should be scrutinized carefully to determine whether they reflect treatment failures due to resistance, non-compliance, or a non-bacterial source of infection. It is rare that an extension of the same therapy is warranted. All healthcare organizations are encouraged to consider the risks of fluoroquinolones when prescribing or renewing this class of medications. Current healthfinch enterprise customers should consider discussing the appropriateness of including these medications in protocol during the next scheduled content review with their Customer Success Manager.
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