[Toxicity of quinolone antibiotics - new untoward effects and reevaluation of known side effects].

Quinolones have recently been reevaluated based on new possible side effects and new risk assessments of known side effects. Several of the recently reported untoward effects are not new to the class, and they are very rare compared with the relatively common neuropsychiatric adverse events. New associations are aortic aneurysm/dissection and long-standing peripheral neuropathy, muscle weakness, mobility and gait disorders with unclear causal relationship to fluoroquinolone treatment and no known effective therapeutic interventions. Based on estimates from comparative data there could be slightly more than 1000 additional cases of adverse drug effects associated with fluoroquinolone treatment versus other common antibiotics per 100 000 treatment episodes - most of them being neuropsychiatric side effects in primary care, tendinopathy and - more rarely and uncertain - liver toxicity. Consequences were safety alerts in the USA and in European countries with recommendations that the use of the marketed fluoroquinolone antibiotics should be restricted and other antibacterial medicines be preferred if possible. The prophylactic use should be abandoned (travellers' diarrhea and prevention of relapsing cystitis) or critically reevaluated and individualized (prevention of neutropenic fever and of spontaneous bacterial peritonitis).