Further curbs on quinolones
The Committee for Human Medicinal Products (CHMP) of the European Medicines Agency (EMA) has endorsed recommendations by their pharmacovigilance committee regarding fluoroquinolones.
They have confirmed that cinoxacin, flumequine, nalidixic acid and pipemidic acid should no longer be marketed and that the use of other quinolones should be restricted. The remaining fluoroquinolones should not be used for the following:
- Treatment of minor/self-limiting infections e.g. throat infections
- Treatment of nonbacterial infections e.g. nonbacterial chronic prostatitis
- Prevention of travellers’ diarrhoea or recurrent lower UTI’s
- Treatment of mild/moderate bacterial infections, unless no other alternative available
Furthermore, they should be used with caution in the elderly, patients with kidney disease and transplant patients as these groups are at higher risk of a tendon injury. Concurrent use of fluoroquinolones with corticosteroids should also be avoided for the same reason.
These restrictions are due to ongoing emerging evidence that the quinolones can rarely cause long-lasting (months to years) or even irreversible reactions including arthralgias, extremity pain, paraesthesias, gait abnormalities, depression, fatigue, impaired memory, and impaired senses (except touch).
The FDA in the United States has also introduced restrictions in recent years.