The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) has announced that the fluoroquinolone class of antibiotics can only be prescribed when no other antibiotic is appropriate for use.

This means that fluoroquinolones, which include ciprofloxacin, delafloxacin, levofloxacin, moxifloxacin and ofloxacin, will only be administered if other recommended antibiotics have failed, will not work due to resistance, or are unsafe to use in an individual patient.

The agency has moved to strengthen its previous restrictions following reports under its Yellow Card scheme from patients who had experienced long-lasting or disabling reactions following their use of fluoroquinolones, which were in some cases prescribed for mild to moderate infections or non-bacterial conditions.

The MHRA first introduced restrictions on the use of fluroquinolones in 2019 limiting their use to serious or life-threatening bacterial infections. Following no change in the pattern of prescribing fluroquinolones in the UK, the agency published a reminder in August 2023 outlining the potentially long-lasting or irreversible side effects of fluoroquinolone antibiotics.

Prior to introducing its latest restrictions, the agency conduced a review into the effectiveness of current measures in reducing the rate of fluroquinolone prescriptions.

“We have listened to the experience of patients regarding long-lasting and potentially irreversible adverse reactions following use of fluoroquinolone antibiotics. We recognise fully the importance of limiting the use of these medicines,” said Dr Alison Cave, the MHRA’s Chief Safety Officer.