Improving Quality of Care: Update of Risks Associated with Use of Fluoroquinolones

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Learning Objectives:

  • Describe the recent U.S. Food and Drug Administration (FDA) drug safety communications for fluoroquinolones.
  • Identify potential adverse effects associated with use of fluoroquinolones.
    Summarize best practices for responsible prescribing of fluoroquinolones.

Key Points:

  • Fluoroquinolones are broad-spectrum antibiotics that are FDA-approved to treat various bacterial infections, including infections caused by gram-negative bacilli.
  • Over the last decade, the FDA has issued multiple drug safety communications
    highlighting potential adverse events associated with use of fluoroquinolones.
  • Fluoroquinolones should not be prescribed to community-dwelling patients who have other treatment options for acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, and uncomplicated urinary tract infection (UTI), as the risks outweigh the benefits.
  • In a study of community-dwelling Medi-Cal fee-for-service beneficiaries, approximately 57% of fluoroquinolone use appeared to be for potentially inappropriate indications, based on FDA recommendations.

Background
Fluoroquinolones, including ciprofloxacin, ofloxacin, gemifloxacin, levofloxacin, and moxifloxacin, are broad-spectrum antibiotics that interfere with the growth of bacteria via inhibition of certain enzymes needed for bacterial replication.1 Fluoroquinolones are FDA-approved to treat various bacterial infections and can be reliably used to treat infections caused by gram-negative bacilli, including strains of antibiotic resistant bacteria.1 As shown in Table 1, most fluoroquinolones appear on the Medi-Cal List of Contract Drugs, with some having restrictions to their use without an approved Treatment Authorization Request (TAR).

Posted on May 5th, 2020 and last modified on May 5th, 2020.

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