Quinolones

Question 1

Tendon damage

Answer 1

Tendon damage (including rupture) has been reported
rarely in patients receiving quinolones. Tendon rupture
may occur within 48 hours of starting treatment; cases
have also been reported several months after stopping a
quinolone. Healthcare professionals are reminded that:
Quinolones are contra-indicated in patients with a
history of tendon disorders related to quinolone use;
Patients over 60 years of age are more prone to tendon
damage;
The risk of tendon damage is increased by the
concomitant use of corticosteroids;
If tendinitis is suspected, the quinolone should be
discontinued immediately

Question 2

Convulsions in quinolones

Answer 2

The CSM has warned that quinolones may induce
convulsions in patients with or without a history of
convulsions; taking NSAIDs at the same time may also
induce them.

Question 3

Systemic and inhaled
fluoroquinolones: small increased risk of aortic
aneurysm and dissection

Answer 3

The MHRA advises that benefit-risk should be assessed and
other therapeutic options considered before using
fluoroquinolones in patients at risk of aortic aneurysm and
dissection.
Patients (particularly the elderly and those at risk) and their
carers should be informed about rare events of aortic
aneurysm and dissection, and advised to seek immediate
medical attention if sudden-onset severe abdominal, chest,
or back pain develops.

Question 4

Systemic and inhaled
fluoroquinolones: small risk of heart valve
regurgitation;

Answer 4

Healthcare professionals are advised that fluoroquinolones
are authorised for use in serious, life-threatening bacterial
infections, and should only be used after careful benefit-
risk assessment and consideration of other therapeutic
options in patients with the following risk factors:
congenital or pre-existing heart valve disease;
connective tissue disorders (e.g. Marfan syndrome or
Ehlers-Danlos syndrome);
other risk factors or conditions predisposing to heart
valve regurgitation (e.g. hypertension, Turner
’
s
syndrome, Behçet’
s disease, rheumatoid arthritis, and
infective endocarditis).
Patients should be advised to seek immediate medical
attention if they experience a rapid onset of shortness of
breath (especially when lying down flat in bed), swelling of
the ankles, feet, or abdomen, or new-onset heart
palpitations.

Question 5

Ciprofloxacin Indications

Answer 5

Moderate to severe foot infection
RTI
UTI
Antrax
Gonorrhoea
Osteomyelitis

Question 6

Ciprrofloxacin MOA

Answer 6

Ciprofloxacin acts on
bacterial topoisomerase II
(DNA gyrase) and
topoisomerase IV.
Ciprofloxacin’s targeting of
the alpha subunits of DNA
gyrase prevents it from
supercoiling the bacterial
DNA which prevents DNA
replication.

Question 7

Ciprofloxacin Cautions

Answer 7

Prolong QT intervals
Diabetes (may affect blood glucose)
Exposure to excessive sunlight and UV should be avoid during and 48hrs after treatment
hx of epilepsy
G6PD deficiency
Myasthenia gravis
Psychiatric disorders

Question 8

Ciprofloxacin spectrum of activity

Answer 8

Gram negative: Neisseria meningitis, Haemophilus influenzae, moraxella, e.coli, klebisella, proteus mirabilis, PSEUDOMONAS

Question 9

SE of ciprofloxacin

Answer 9

Drug should be discontinued if neurological, psychiatric, tendon disorders or hypersensitivity reactions (including severe rash) occur

Question 10

Levofloxacin

Answer 10

Levofloxacin is a third-generation fluoroquinolone, and compared to ciprofloxacin, it has:
✅ Broader gram-positive coverage,
✅ Retains good gram-negative activity,
✅ Better respiratory tract penetration,
but ❌ still poor anaerobic activity.