why are fluoroquinolones not recommend as the first antibiotic of choice for bacterial diseases?

First and foremost because of the unacceptable safety profile associated with this class. This class has an adverse drug reaction rate (one or more reactions) in excess of 40%. The most troubling reactions being spontaneous tendon ruptures as well as irreversible peripheral neuropathy. There are a significant number of patients who never recover from these adverse reactions and these become permanent disabilities. There is a grass root movement that has been in effect for more than a decade to severely restrict the use of this class. There are currently thousands of lawsuits pending in Federal Court concerning the lack of sufficient warnings and allegations that the manufacturers have minimize and trivialized the severity and duration of these reactions. Thereby deliberately preventing full disclosure to both the treating physician as well as the patient.

Some of the other more significant risks include the risks of QT prolongation which is an EKG abnormality which may lead to fatal heart attacks, severe liver, and kidney damage requiring transplants, TENs, SJS and other disfiguring skin reactions. The risk of suffering a fatal, severe or permanent reaction is far greater with this class than any other antibiotic in clinical use today.

The medical community being unaware of these risks is far more concerned about the organism to be treated becoming resistant to the fluoroquinolone chosen, or may become resistant, or a that resistant organism infection might be a greater risk to develop in a close contact to the treated patient, than they are about this classes safety profile. And would restrict its use for that reason (resistance) alone.

Director

Fluoroquinolone Toxicity Research Foundation

Top of the list: they are associated with increased risk of fostering Clostridium difficile gastreoenteritis (in susceptible patients, especially hospitalized patients with no food intake or other dietary disruption) or the development of MRSA infections (again, especially in ICU or other hospitalized patients) when the patient may come in contact of sources for MRSA colonization (this could be virtually everyone, at least in the US).

Second: risks of QT prolongation (EKG abnormaility which might lead to arrhythmia) or tendonitis, Elderly hospitalized patients might also have aggravation of confusion or other cognitive impairment, when treated with a fluoroquinolone.

Third: the organism to be treated may be resistant to the fluoroquinolone chosen, or may become resistant, or a resistant organism infection might be a greater risk to develop in a close contact to the treated patient.

This does still leave some situations for using a fluoroquinolone as a first-line therapy for an infection LIKELY to have been caused by a susceptible organism.

Fluoroquinolones MIGHT be chosen appropriately for the treatment of some patients with urinary tract infections; in particular, hospitalized p;atients wth pyelonephritis might be treated with a fuoroquinolone and/or other antibiotics.

Rex, a physician, in the midwest