INTRODUCTION
Antibiotics save lives, but not all of them are risk free. Fluoroquinolones such as ciprofloxacin, levofloxacin, and moxifloxacin are widely prescribed in South Asia for urinary tract infections, typhoid, and pneumonia.
In my opinion as a pharmacist, these drugs are often used too casually, even though research clearly shows they can cause serious, sometimes permanent harm.
WHAT ARE FLUOROQUINOLONES?
Fluoroquinolones are broad-spectrum antibiotics that block bacterial DNA replication, making them effective against a wide range of infections.
Common drugs include: ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin, and norfloxacin.
Let’s break it down: they are commonly given for:
• Urinary tract infections (UTIs) when bacteria resist other options
• Typhoid fever a serious and sometimes life-threatening illness
• Pneumonia and bronchitis especially in resistant cases
• Prostatitis bacterial infection of the prostate
• Skin, bone, and joint infections when deeper tissues are affected
But here’s the issue in South Asia, ciprofloxacin is often used like paracetamol, even without a prescription.
WHY GLOBAL HEALTH AGENCIES WARNED AGAINST OVERUSE
Over the past decade, regulators worldwide have sounded the alarm:
• 2008 (FDA): Black-box warning for tendon rupture
• 2016 (FDA): Recommended avoiding use in mild infections (like simple UTIs, sinusitis, bronchitis)
• 2018 (FDA): Added risk of aortic aneurysm and dissection
• 2023 (UK MHRA): Warned of “potentially irreversible side effects.”
These alerts are not just bureaucratic paperwork. They are based on real patient harm documented in scientific research.
SCIENTIFIC EVIDENCE BEHIND THE WARNINGS
• First, a 2019 JAMA Neurology study found fluoroquinolones linked to a higher risk of peripheral neuropathy (nerve damage).
• Next, a 2024 ScienceDirect study reported levofloxacin increased the risk of Achilles tendon rupture (HR 2.20; 95% CI 1.50–3.24).
• Finally, a 2024 Frontiers in Pharmacology review highlighted ciprofloxacin’s association with depression and suicidal ideation, while moxifloxacin was linked with delirium.
In my opinion, these studies show that the risks are not rare they are consistent and concerning.
COMMON SERIOUS SIDE EFFECTS
Now, let’s connect the science to real life patient concerns. The risks highlighted by studies often translate into these everyday problems:
1. TENDON DAMAGE
Let’s break it down: fluoroquinolones weaken collagen, which holds tendons together. The Achilles tendon is most often affected, and ruptures can happen even months after stopping the medicine.
2. PERIPHERAL NEUROPATHY
This shows up as burning, tingling, or numbness in the hands and feet.
What’s worrying is that the damage may be permanent even after short use.
3. CARDIOVASCULAR RISKS
Patients may face a higher chance of aortic aneurysm and dissection, particularly if they already have heart disease or hypertension.
4. MENTAL HEALTH EFFECTS
Symptoms can include confusion, tremors, anxiety, insomnia, or even hallucinations.
In my opinion, this is the most underestimated risk. Too often, patients blame “stress” or “age” when in reality, the antibiotic is the trigger.
5. OTHER CONCERNS
• First, fluoroquinolones can cause dangerous blood sugar swings especially risky for diabetics.
• Second, they may increase sun sensitivity, leading to severe skin reactions.
• Finally, they can worsen muscle weakness in patients with myasthenia gravis.
WHO IS AT HIGHER RISK?
Understanding side effects is important, but equally important is knowing who faces the highest risk.
• Older adults (over 60 years) tendons naturally weaken with age.
• Patients with kidney disease slower drug clearance increases toxicity.
• Those on corticosteroids risk of tendon rupture multiplies.
• People with past tendon issues already vulnerable to injury.
• Patients with heart disease or aneurysm history higher cardiovascular risk.
Let’s break it down: while these groups are clearly at higher risk, studies also show that even young, healthy adults can suffer serious side effects.
WHY ARE THEY STILL PRESCRIBED?
At this point, you may wonder: if the risks are so serious, why do doctors continue prescribing these antibiotics?
• First, they remain powerful against multi-drug-resistant bacteria.
• Second, in life-threatening infections, their broad coverage can be lifesaving.
• Finally, in some cases, no safer alternatives are available.
In my opinion as a pharmacist, fluoroquinolones should never be the first choice for mild infections like simple UTIs or sinusitis.
SAFER ALTERNATIVES
Fortunately, the good news is that safer options are available for many common infections.
• For UTIs: Nitrofurantoin, Fosfomycin, or Trimethoprim-sulfamethoxazole
• For respiratory infections: Amoxicillin-clavulanate, Doxycycline, or Azithromycin
• For skin infections: Clindamycin, Cephalosporins, or Penicillins
Let’s break it down: while no antibiotic is completely risk-free, these choices generally carry fewer long-term dangers compared to fluoroquinolones.
PHARMACIST’S PERSPECTIVE
Here’s where things get personal. In South Asia, antibiotics like ciprofloxacin and levofloxacin are still sold like over-the-counter painkillers.
In my opinion as a pharmacist, this is dangerous because:
• Patients are rarely screened for kidney, tendon, or heart risk factors.
• Adverse effects go unnoticed until it’s too late.
• Widespread misuse fuels antibiotic resistance.
Let’s break it down: fluoroquinolones should be reserved for serious cases only. Treating them like “everyday antibiotics” is a mistake that harms both patients and communities.
WHAT PATIENTS SHOULD DO
So, what does this mean for you as a patient? Let’s break it down into simple action steps:
• Before treatment: Ask your doctor if a safer alternative is available.
• During treatment: Stop immediately if you feel tendon pain, tingling, or confusion.
• After treatment: Remember that side effects may appear weeks later don’t ignore new symptoms.
FINAL WORDS
Fluoroquinolones are powerful but risky. They can save lives in serious infections, but they should never be used casually.
In my opinion as a pharmacist, the safest approach is simple:
• Don’t self-medicate.
• Always ask about alternatives.
• Report unusual symptoms quickly.
Your health deserves caution—not unnecessary risks.
FAQs
1. Are ciprofloxacin and levofloxacin safe for everyone?
No. Older adults, people with kidney disease, those on steroids, and patients with heart or tendon problems face higher risks. Even healthy adults can sometimes develop serious side effects.
2. Can side effects appear after stopping the medicine?
Yes. Tendon rupture and nerve damage may develop weeks or months after finishing the antibiotic.
3. Are all fluoroquinolones equally risky?
Yes, though certain risks differ slightly by drug. For example, ciprofloxacin has been linked with depression, while levofloxacin shows stronger tendon damage association.
4. What should I do if I experience tendon pain or nerve tingling?
Stop the antibiotic immediately and seek medical advice. Do not restart the medication without your doctor’s approval.
5. Why are doctors still prescribing these antibiotics?
Because in some life-threatening infections, they may be the only effective option against resistant bacteria.
6. What are safer alternatives for mild infections?
Options may include nitrofurantoin (for UTIs), doxycycline or amoxicillin-clavulanate (for respiratory infections), and cephalosporins (for skin infections). Always confirm with your doctor.
DISCLAIMER
This article is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your doctor or pharmacist before starting, stopping, or changing any medication. Do not self-medicate with antibiotics.
CALL TO ACTION
If you found this article useful, share it with friends and family to spread awareness about antibiotic safety.
Have you or someone you know experienced side effects from ciprofloxacin or levofloxacin? Share your story in the comments below it could help others stay informed.
REFERENCES
1. U.S. Food and Drug Administration (FDA). FDA Drug Safety Communication: Fluoroquinolone Antibiotics. 2008, 2016, 2018.
2. Medicines and Healthcare products Regulatory Agency (MHRA). Fluoroquinolone antibiotics: reminder of disabling and potentially long-lasting side effects. 2023.
3. Etminan M, et al. Oral Fluoroquinolone Use and Risk of Peripheral Neuropathy: A Pharmacoepidemiologic Study. JAMA Neurology. 2019;76(2):172–174.
4. Park JW, et al. Risk of Achilles tendon rupture associated with fluoroquinolone use: A nationwide cohort study. ScienceDirect, 2024.
5. Frontiers in Pharmacology. Neuropsychiatric adverse effects of fluoroquinolones: A systematic review. 2024.
