Education and debate

Lesson of the Week: Dangers of oral fluoroquinolone treatment in community acquired upper respiratory tract infections

Department of Medical Microbiology and Regional Antimicrobial Reference Laboratory, Southmead Health Services NHS Trust, Westbury- on-Trym, Bristol BS10 5NB Correspondence to: Dr Korner.

Respiratory tract infections are among the commonest presenting to general practitioners. Upper respiratory tract infections of bacterial origin, such as acute otitis media and sinusitis, are commonly caused by Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes, and Moraxella catarrhalis. Lower respiratory tract infections, such as pneumonia, are most commonly caused by Streptococcus pneumoniae^2,3 followed by Mycoplasma pneumoniae.⁴ The antimicrobial agents most often used for empirical treatment of these infections are amoxycillin, co-amoxiclav, and erythromycin. We have noticed that fluoroquinolones such as ciprofloxacin and ofloxacin are increasingly being used to treat community acquired upper respiratory tract infection even though they have poor activity against S pneumoniae. We report here two cases of life threatening systemic pneumococcal infection originating in the upper respiratory tract in which a fluoroquinolone was prescribed unsuccessfully as first line empirical antibiotic treatment.

Case 1

A previously fit 28 year old woman was admitted with acute . . . [Full text of this article]

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