Based on data from recent studies, fluoroquinolone antibiotics “continue to be prescribed outside their recommended uses.”
However, since “they are associated with very rare but serious, disabling, long-lasting and potentially irreversible adverse reactions”, these medicines must be prescribed “only in the approved indications and after a careful evaluation of the benefits and risks on the individual patient”.
This is indicated by a note published by the Italian Medicines Agency.
The risks associated with inappropriate intake of fluoroquinolones
The document released by AIFA and addressed to doctors follows the analogous indication provided since 2019 by the European Medicines Agency for fluoroquinolones for systemic and inhaled use (ciprofloxacin, delafloxacin, levofloxacin, lomefloxacin, moxifloxacin, norfloxacin, ofloxacin, pefloxacin , prulifloxacin and rufloxacin).
An opinion following the conclusions of a review to assess the risk of “serious and long-lasting, disabling and potentially irreversible adverse reactions affecting the musculoskeletal and nervous systems”.
Namely: tendonitis, tendon rupture, pain in extremity, gait disturbance, neuropathies, depression, fatigue, memory impairment, hallucinations, psychosis, sleep disturbances and sensory disturbances.
Who is at risk more? The memorandum of the Italian Medicines Agency
In particular, underlines the Agency, tendon damage can occur within 48 hours of treatment or several months after interruption. And the risk is higher in patients treated with corticosteroids, in the elderly, in people with kidney failure or who have undergone transplants.
Fluoroquinolones, AIFA recalls, must not be prescribed to patients who have already had serious adverse reactions with a quinolone antibiotic, with infections that are not serious (such as pharyngitis, tonsillitis and acute bronchitis) or mild to moderate (including uncomplicated cystitis, exacerbation of chronic bronchitis, acute bacterial rhinosinusitis and acute otitis media). Unless the other antibiotics recommended for these conditions are deemed inappropriate.
Fluoroquinolones should also not be prescribed to prevent traveler’s diarrhea or recurrent lower urinary tract infections.