The
quinolone antibacterials are proving very useful in the management of
infection, notably for the treatment of Gram-negative bacteria. With the increasing use of these drugs, adverse effects are being recognised more often and careful documentation is still required. In general, the
quinolones are of low toxicity. Gastrointestinal adverse effects are the most common, and are usually mild; indeed, all adverse events are generally mild and resolve on withdrawal of the offending
drug. Certain precautions and
contraindications are apparent. Because
drug-induced
arthropathies occur in juvenile animals,
quinolones should not be administered to pregnant or lactating women or to growing children, unless the clinical benefit outweighs the risk. Caution should also be observed in patients with previous
epilepsy or severe
cerebral arteriosclerosis. Neurological effects may require the use of appropriate neuro- and
psychoactive drugs, as well as the withdrawal of the precipitating agent.
Hypersensitivity reactions to a
fluoroquinolone may require the use of
antihistamines, and in some cases topical or systemic
steroids, and may well preclude future use of a
fluoroquinolone. Dose adjustments may be necessary in patients with reduced renal function, when the measurement of serum concentrations may be desirable.
Interstitial nephritis, haematuria and
acute renal failure are rare effects of
quinolone therapy which will require appropriate management including withdrawal of the precipitating
drug. Interactions with
theophylline and
warfarin are of clinical significance, and may require plasma concentration monitoring and adjustment of dosage.