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GPs could face quinolone antibiotics prescribing restrictions from next year

GPs could see tighter controls placed on quinolone antibiotics from next year, after the European Medicines Agency called for certain medicines containing this class of antibiotics to be suspended, and for others to be restricted.

This comes after the EMA launched a review into the class of broad spectrum antibiotics earlier this year, following reports of ‘serious, disabling and potentially permanent side effects’.

In response, the UK Government medicines regulator said it will put the changes into effect once they are finalised by the European Commission in early 2019.

The EMA review incorporated views from patients, healthcare professionals and academics - all of which were presented at EMA’s public hearing in June 2018.

It covered medicines containing the following fluoroquinolone and quinolone antibiotics: cinoxacin, ciprofloxacin, flumequine, levofloxacin, lomefloxacin, moxifloxacin, nalidixic acid, norfloxacin, ofloxacin, pefloxacin, pipemidic acid, prulifloxacin and rufloxacin.

In a statement released earlier this month, the EMA said: 'EMA has reviewed serious, disabling and potentially permanent side effects with quinolone and fluoroquinolone antibiotics given by mouth, injection or inhalation...

'EMA’s human medicines committee (CHMP) has endorsed the recommendations of EMA’s safety committee (PRAC) and concluded that the marketing authorisation of medicines containing cinoxacin, flumequine, nalidixic acid, and pipemidic acid should be suspended. The CHMP confirmed that the use of the remaining fluoroquinolone antibiotics should be restricted.'

The EMA said that restrictions on the remaining fluoroquinolone antibiotics will mean that they should not be used to treat infections that might get better without treatment or are not severe, or for recurring lower urinary tract infections.

They should ‘generally be avoided in patients who have previously had serious side effects with a fluoroquinolone or quinolone antibiotic’ or those taking a corticosteroid, and used with ‘special caution in the elderly, patients with kidney disease and those who have had an organ transplantation’, the body added.

Following the calls for restrictions, an MHRA spokesperson said: ‘MHRA has taken part in the ongoing EU review of the disabling and potentially long-lasting side effects reported with these medicines.

‘The PRAC recommended restricting the use of fluoroquinolone antibiotics. These recommendations are now subject to further EU consideration and will take effect once a European Commission decision is issued.’

‘Once the decision is finalised in early 2019, the licences in the UK will be updated and we will communicate the new advice to healthcare professionals and patients,’ they added.

BMA GP Committee clinical and prescribing policy group member Dr Zoe Norris said: ‘I think there will need to be a very clear way of letting GPs know when this comes into force.'

She continued: ‘It goes alongside the general move and the latest NICE guidance on reducing antibiotic prescribing, but there is still a vast amount of work to be done with patients.

‘NHS England and the Department of Health and Social Care have still done very little to directly and forcibly challenge patient beliefs and behaviour around antibiotic prescribing. We need support to be able to implement a reduction in antibiotic prescribing, whether done in response to general guidance or more specific alerts such as this.’

Earlier this year, NHS England launched a new scheme to tackle antimicorbial resistance which could see GPs use point-of-care before they prescribe antibiotics.

As part of the Government-led drive to decrease antibiotic prescribing, Public Health England also launched a public awareness campaign to stop patients pressuring GPs for antibiotics.

Readers' comments (9)

  • may lead to increased admissions. Often there is little choice based on culture results. Only other option is admit for IV.

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  • Quinolones the the favourite antibiotic of the poultry farmer.

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  • Going to create problems for some of the COPD suffers who have little choice because of allergy + resistance. Very well if we cant prescribe then they will get admitted for IV antibiotics. Let NHSE worry about that not us.

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  • i have never used quinolones in copd, it just causes drug resistant pseudomonas infections which then colonise the lungs and can't be removed. if you don't prescribe them in the first place you don't end up with the consequences. most copd is more inflammation rather then infection so they don't always need antibiotics - primary care respiratory society has downloads on these you can read for more information. don't prescribe cephalosporins either as increases the risk of clostridium difficle. ( as do quinolones). manage fine without them.

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  • agree with many of these comments- and easily available OTC in Asia if there concerns about drug resistance.Very useful drugs when used sensibly.

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  • AlanAlmond

    The biggest problem is with individuals with multiple allergies and various contraindications, sometimes there is no other choice available - other than an admission to hospital for an exotic IV. I’m not convinced enough thought is given to these atypical situations, they crop up surprisingly frequently. Is hospital admission really the safest option in the cost benefit analysis for these labyrinthine individuals? The complexity of some folks medical history +/- allergy/intolerance profile +/- renal and liver issues +/- potential for drug interactions is vast, and these folk amble in to GP clinics up and down the country, feeling ill, with bacterial infections every single day of the week. This stuff ain’t easy.

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  • Took Early Retirement

    Back to Chloramphenicol then.

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  • David Banner

    Hmmm, posters and leaflets discouraging patients from asking for antibiotics, there’s a novel idea.
    If you have a lab result stating cipro is the only oral option, then you can prescribe (and be damned), not prescribe (and be damned), or admit for far more precious IVs (and be damned).
    GP as whipping boy....yet again.

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  • Just Your Average Joe

    Use quinolones a handful of times a year when only choice with resistant bugs and have no real issue with restrictions for safety reasons.

    As mentioned - the vast unchecked quantities being used in agriculture and abroad need sorting out. Something the EU should have sorted out years ago and would have help restrict antibiotic overuse in non medical circumstances.

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