Tolerability of fluoroquinolones - Focus on pefloxacin

The tolerability of the fluoroquinolones is particularly pertinent in the context of widespread prescription of this category of antibiotics. The most frequent adverse events associated with fluoroquinolones involve the digestive tract, the central nervous system, the skin and the musculoskeletal system. In comparison with the nonfluorinated quinolones, some specific adverse events have been described, such as chondrotoxicity, tendinitis of the Achilles' tendon with possible rupture and acute myositis. All of the adverse events associated with fluoroquinolones resolve spontaneously upon treatment discontinuation with the exception of chondrotoxicity and tendinitis, which may be responsible for sequelae. Chondrotoxicity contraindicates the use of fluoroquinolones in children and pregnant women. Further data are required on the long term tolerability of fluoroquinolones in relation to their effects on DNA metabolism. Pefloxacin appears to have a tolerability profile similar to that of ciprofloxacin or ofloxacin; the choice of one of these agents should therefore depend on differences in their pharmacological properties in relation to the clinical needs of individual patients.