Fluoroquinolone antibiotics

Patient Information

Pharmacy Department

Author ID:           MJD

Leaflet Ref:         Pharm 002

Version:              2 

Leaflet title:         Fluoroquinolone antibiotics

Date Produced:   September 2023

Expiry Date:        September 2025

What are fluoroquinolone antibiotics?

They are a family of antibiotics used to treat severe infections caused by bacteria. You may be prescribed ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin or delafloxacin.

 When would I be given them?

Your doctor may decide to give you a fluouroquinolone if it is the most effective antibiotic for your infection, or because there is a reason you cannot have other antibiotics. They will only do so after carefully considering the risks and benefits to you over other options. Fluroquinolones can be used on their own, but they can also be used together with other antibiotics.

How should I take them?

Usually fluoroquinolones are taken orally once or twice a day. Dairy products (e.g. milk or yoghurt) or foods/drinks with added calcium, iron and/or magnesium may reduce how well the antibiotics are absorbed by the body. You should take your fluoroquinolone at least 1 to 2 hours before, or at least 4 hours after, these products. You could also have them given into a vein via a drip, where there are no concerns about how the treatment may react with your food.

What problems can they cause?

Fluoroquinolones can cause rare but serious side effects involving tendons, muscles, joints, blood vessels, heart valves and nerves. In a small number of patients these effects may be long-lasting or permanent. These risks, and ways to reduce them, wil be addressed with you by your doctor before starting treatment, and thay are outlined below.

If you experience any of the following symptoms stop taking your fluroquinolone and contact your doctor immediately:

• Tendon pain or swelling, often at the beginning of the ankle or calf. These usually happen within 48 hours of starting treatment, however this could occur several months after stopping treatment.
• Pain in your joints or swelling in your shoulders, arms, or legs.
• Abdominal pain or sensations (e.g. pins and needles, tingling, tickling or numbness) especially in the legs or arms.
• Weakness in your body or difficulty walking.
• Persistent diarrhoea or stools containing blood or mucus.
• Seizures.

• Leaking heart valves. You may experience:
  • Rapid onset of shortness of breath (especially when lying flat).
  • Swelling of the ankles, feet, or abdomen.
  • New onset heart palpitations.
  • Damage to a major blood vessel – the aorta. You may experience:
  • Sudden onset severe pain in the abdomen, back, or chest.

What can be done to reduce the chance of problems happening?

You may be at greater risk of side effects if you have previously had any serious side effects with fluoroquinolones.

Your risk of side effects involving tendons, muscles, joints and nerves may be higher if: 

• You are over 60 years old.
• Your kidneys do not work well.

Your risk of diarrhoea may be higher if:

• You have had other antibiotics recently.
• You have previously had C. diff diarrhoea.

Your risk of seizures may be higher if:

• You have a history of seizures.
• You are taking non-steroidal anti-inflammatory medication (such as ibuprofen).

Your risk of leaking heart valves may be higher if:

• You already have heart valve disease.
• You have a connective tissue disorder such as: Marfan syndrome, Ehlers-Danlos syndrome.
• You have risk factors for leaking heart valves such as: high blood pressure, Turner’s syndrome, Behçet’s disease orrheumatoid arthritis.

Your risk of aorta damage may be higher if:

• You have a family history of aneurysm disease.
• You already have an aortic aneurysm or aortic dissection.
• You have risk factors for aorta damage such as: high blood pressure, atherosclerosis, Marfan syndrome, Ehlers-Danlos syndrome, Takayasu or giant cell arteries or Behçet’s disease.

Is there anything that I can do?

Before starting a fluoroquinolone please tell your doctor, nurse or pharmacist if you have any of the risk factors listed,  or myasthenia gravis. You should also inform them if you are, or there is a chance you are, pregnant.

It is important that you tell your doctor if you are taking any other medicines, including over the counter medicines (bought from a pharmacy) or herbal remedies, because fluoroquinolones may not mix well with some other medicines.

Who can I speak to if I have any questions? 

This leaflet has been produced specially to provide information about the side effects that fluoroquinlones can have. 

If you want more information about other side effects there are patient information leaflets (PILs) produced by the manufacturers, available in each box of medicine. You can ask the nursing staff caring for you to give you the manufacturer’s leaflet, or you can find it online at www.medicines.org.uk. 

The doctors caring for you will also be happy to answer any questions you may have. You can also ask to speak to one of the hospital pharmacists or nurses caring for you, or discuss the treatment with your local community or practice pharmacists.