Fluoroquinolone toxicity profiles: A review focusing on newer agents

For 2 decades fluoroquinolones have been found to be generally well-tolerat ed and safe. Adverse events may be inherent to the class or influenced by s tructural modifications. The commonest adverse events are gastrointestinal tract (GI) and central nervous system (CNS) reactions; nephrotoxicity and t endinitis are infrequent, but agents differ greatly in phototoxic potential . Fluoroquinolones are safe in elderly, human immunodeficiency virus-infect ed, and neutropenic patients, but because of possible effects on articular cartilage, they are not currently recommended for children or pregnant wome n. Four new agents have recently been licensed. Levofloxacin causes few GI or CNS adverse events and is minimally phototoxic. Sparfloxacin infrequentl y causes GI or CNS effects but is associated with relatively high rates of phototoxicity and prolongation of the electrocardiographic QT(c) interval ( Q-T interval, corrected for head rate). Grepafloxacin causes relatively hig h rates of GI effects, taste perversion, and QT(c) interval prolongation, b ut it is minimally phototoxic. Trovafloxacin is associated with a moderate rate of GI effects and a relatively high incidence of dizziness but has low phototoxic potential.