Emergency Department Recommendations for Non-Admitted Patients

Emergency Department Recommendations for Non-Admitted Patients

General Principles

  • The fluoroquinolone class of antibiotics have been associated with adverse events throughout the years (see Timeline of Adverse Events for Fluoroquinolones below)
  • On December 20, 2018, the FDA addressed that there is an increased occurrence of aortic dissections in patients with a history of blockages or aneurysms of the aorta or other blood vessels, high blood pressure, certain genetic disorders that involve blood vessel changes, and the elderly
  • 1962: First FQ introduced
  • 2008: Black box warning: tendinitis and tendon rupture
  • 2011: Black box warning: worsening myasthenia gravis
  • 2013: Updated labeling: potentially irreversible peripheral neuropathy
  • 2016: FDA enhanced label warnings: possible permanent side effects (joint pain, tendon rupture, tendinitis, anxiety, depression and altered mental status)
  • 2018: Safety communication: adverse psychiatric effects and hypoglycemic risks
  • 2018: FDA warning: increased risk of ruptures or tears in the aorta

Due to additional serious safety concerns, fluoroquinolones should not be used when other treatment options are available

More Information

IDSA Guidelines: for included infections. Available at:, Johns Hopkins Antibiotic Guide, Sanford Guide of Antimicrobial Therapy, FDA, CDC.