Fluoroquinolone Adverse Effects and Drug Interactions

Abstract

Extensive pharmacologic and clinical development of quinolone antimicrobial agents has resulted in improved antimicrobial activity, pharmacokinetic features, toxicity, and drug‐drug interaction profiles. Nalidixic acid and other early quinolones had limited use due to poor pharmacokinetics, relatively narrow antimicrobial spectrum of activity, and frequent adverse effects. Beginning with the development of fluoroquinolones, such as norfloxacin and ciprofloxacin, in the 1980s, the agents assumed a greatly expanded clinical role because of their broad antimicrobial spectrum of action, improved pharmacokinetic properties, and more acceptable safety profile. Although the pharmacokinetics and efficacy of the drugs have improved significantly, a major area of continued emphasis is to further reduce the frequency and severity of adverse events and drug‐drug interactions. Older agents such as ciprofloxacin and ofloxacin are still extensively prescribed, but the focus of this article is on the newer fluoroquinolones (levofloxacin and other drugs that have been approved or have been under investigation since approximately 1997).

Nitric oxide and the hyperdynamic circulation in cirrhosis: is there a role for selective intestinal decontamination?

“…Norfloxacin is generally well tolerated [63], as observed in data collected from previous randomized controlled studies. The need to withdraw the drug is extremely uncommon, the major side effects reported include those that involve the gastrointestinal tract (most often nausea) and the central nervous system (most often headache and lightheadedness).…”

Pharmacokinetic and dynamic study of levofloxacin and rifampicin in bone and joint infections

“…As far as we know, no drug interactions has ever been reported between rifampicin and levofloxacin [37] and this was the case in our study. This should be compared to the absence of any significant hepatic metabolism for this fluoroquinolone (it is excreted mainly through the urinary tract in an unchanged form) [6].…”

Monitoring, evaluation and comparison of adverse effect profile of ciprofloxacin and ofloxacin in acute bacterial exacerbation of chronic bronchitis patients attending pulmonology department of tertiary care teaching hospital: a prospective observational study

“…In few earlier studies insomnia has been reported in about 4.7% of patients treated with ofloxacin, while psychosis occurs in <1% of patients. 8,9 Therefore, reports of insomnia are expected with quinolones, as well as delirium and psychosis. Insomnia has also been reported to the French database as a common ADR (8%).…”