Fluoroquinolones for Dermatologists: A Practical Guide to Clinical Use and Risk Management
<b>Background:</b> Fluoroquinolones, available in topical and oral formulations, are used to manage bacterial skin and soft tissue infections, including <i>Pseudomonas aeruginosa</i>, atypical mycobacteria, and select multidrug-resistant Gram-negative organisms. Their excelle...
Saved in:
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-05-01
|
| Series: | Pharmaceuticals |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1424-8247/18/6/800 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850165392022962176 |
|---|---|
| author | Samer Wahood Omar Alani Iyla Draw Lara Shqair David Wang Christopher G. Bunick Giovanni Damiani Jonathan D. Ho Sabine Obagi Hossein Akbarialiabad Fabrizio Galimberti Mahmoud Ghannoum Ayman Grada |
| author_facet | Samer Wahood Omar Alani Iyla Draw Lara Shqair David Wang Christopher G. Bunick Giovanni Damiani Jonathan D. Ho Sabine Obagi Hossein Akbarialiabad Fabrizio Galimberti Mahmoud Ghannoum Ayman Grada |
| author_sort | Samer Wahood |
| collection | DOAJ |
| description | <b>Background:</b> Fluoroquinolones, available in topical and oral formulations, are used to manage bacterial skin and soft tissue infections, including <i>Pseudomonas aeruginosa</i>, atypical mycobacteria, and select multidrug-resistant Gram-negative organisms. Their excellent tissue penetration, bactericidal activity, and convenient dosing make them effective for certain skin and soft tissue infections. However, their use is limited by potential safety concerns, including tendinopathy (odds ratio up to 9.1 in corticosteroid users), QT interval prolongation with risk of torsades de pointes, phototoxicity, and rising antimicrobial resistance. <b>Methods:</b> A literature search of PubMed, Scopus, and Web of Science was conducted for articles from January 1985 to April 2025 with the search terms (quinolone OR fluoroquinolone) AND (dermatology OR “skin and soft tissue infection” OR “skin structure infection”). Abstracts and presentations were excluded. A Google search used the same terms for articles from government regulatory agencies. <b>Results:</b> This review provides practical guidance on the clinical use of topical and oral fluoroquinolones in dermatology. Delafloxacin demonstrated over 90% cure rates in trials for complicated skin infections. However, serious safety concerns remain, including a ninefold increase in tendinopathy risk among older adults on corticosteroids and corrected QT intervals exceeding 500 milliseconds in high-risk patients. Phototoxicity varies, with agents like sparfloxacin linked to heightened ultraviolet sensitivity. Resistance to ciprofloxacin exceeds 20 percent in <i>Escherichia coli</i> and <i>P. aeruginosa</i> in some populations. Culture-based prescribing, shorter treatment courses, and preference for topical treatments can reduce risk and preserve efficacy. <b>Conclusions:</b> Fluoroquinolones remain clinically useful in dermatology when prescribed selectively. Their appropriate use requires careful attention to patient risk factors along with their evolving resistance patterns and ongoing stewardship efforts. |
| format | Article |
| id | doaj-art-9203d9e874534c3eb1ab18e0453485d3 |
| institution | OA Journals |
| issn | 1424-8247 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Pharmaceuticals |
| spelling | doaj-art-9203d9e874534c3eb1ab18e0453485d32025-08-20T02:21:46ZengMDPI AGPharmaceuticals1424-82472025-05-0118680010.3390/ph18060800Fluoroquinolones for Dermatologists: A Practical Guide to Clinical Use and Risk ManagementSamer Wahood0Omar Alani1Iyla Draw2Lara Shqair3David Wang4Christopher G. Bunick5Giovanni Damiani6Jonathan D. Ho7Sabine Obagi8Hossein Akbarialiabad9Fabrizio Galimberti10Mahmoud Ghannoum11Ayman Grada12The Warren Alpert Medical School of Brown University, Providence, RI 02903, USADepartment of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USADepartment of Dermatology, University of Louisville School of Medicine, Louisville, KY 40202, USADepartment of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USAChobanian & Avedisian School of Medicine, Boston University, Boston, MA 02118, USADepartment of Dermatology and Program in Translational Biomedicine, Yale School of Medicine, New Haven, CT 06520, USADepartment of Dermatology, University of Milan, 20122 Milan, ItalyDepartments of Dermatology and Pathology, The University of the West Indies, Mona Campus, Kingston 7, JamaicaDepartment of Dermatology, University of Arizona College of Medicine, Tucson, AZ 85724, USADepartment of Dermatology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84112, USADepartment of Dermatology, Conway Medical Center, Conway, SC 29526, USADepartment of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USADepartment of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA<b>Background:</b> Fluoroquinolones, available in topical and oral formulations, are used to manage bacterial skin and soft tissue infections, including <i>Pseudomonas aeruginosa</i>, atypical mycobacteria, and select multidrug-resistant Gram-negative organisms. Their excellent tissue penetration, bactericidal activity, and convenient dosing make them effective for certain skin and soft tissue infections. However, their use is limited by potential safety concerns, including tendinopathy (odds ratio up to 9.1 in corticosteroid users), QT interval prolongation with risk of torsades de pointes, phototoxicity, and rising antimicrobial resistance. <b>Methods:</b> A literature search of PubMed, Scopus, and Web of Science was conducted for articles from January 1985 to April 2025 with the search terms (quinolone OR fluoroquinolone) AND (dermatology OR “skin and soft tissue infection” OR “skin structure infection”). Abstracts and presentations were excluded. A Google search used the same terms for articles from government regulatory agencies. <b>Results:</b> This review provides practical guidance on the clinical use of topical and oral fluoroquinolones in dermatology. Delafloxacin demonstrated over 90% cure rates in trials for complicated skin infections. However, serious safety concerns remain, including a ninefold increase in tendinopathy risk among older adults on corticosteroids and corrected QT intervals exceeding 500 milliseconds in high-risk patients. Phototoxicity varies, with agents like sparfloxacin linked to heightened ultraviolet sensitivity. Resistance to ciprofloxacin exceeds 20 percent in <i>Escherichia coli</i> and <i>P. aeruginosa</i> in some populations. Culture-based prescribing, shorter treatment courses, and preference for topical treatments can reduce risk and preserve efficacy. <b>Conclusions:</b> Fluoroquinolones remain clinically useful in dermatology when prescribed selectively. Their appropriate use requires careful attention to patient risk factors along with their evolving resistance patterns and ongoing stewardship efforts.https://www.mdpi.com/1424-8247/18/6/800fluoroquinoloneskindermatologybacteriaantibiotic stewardshiptendinopathy |
| spellingShingle | Samer Wahood Omar Alani Iyla Draw Lara Shqair David Wang Christopher G. Bunick Giovanni Damiani Jonathan D. Ho Sabine Obagi Hossein Akbarialiabad Fabrizio Galimberti Mahmoud Ghannoum Ayman Grada Fluoroquinolones for Dermatologists: A Practical Guide to Clinical Use and Risk Management Pharmaceuticals fluoroquinolone skin dermatology bacteria antibiotic stewardship tendinopathy |
| title | Fluoroquinolones for Dermatologists: A Practical Guide to Clinical Use and Risk Management |
| title_full | Fluoroquinolones for Dermatologists: A Practical Guide to Clinical Use and Risk Management |
| title_fullStr | Fluoroquinolones for Dermatologists: A Practical Guide to Clinical Use and Risk Management |
| title_full_unstemmed | Fluoroquinolones for Dermatologists: A Practical Guide to Clinical Use and Risk Management |
| title_short | Fluoroquinolones for Dermatologists: A Practical Guide to Clinical Use and Risk Management |
| title_sort | fluoroquinolones for dermatologists a practical guide to clinical use and risk management |
| topic | fluoroquinolone skin dermatology bacteria antibiotic stewardship tendinopathy |
| url | https://www.mdpi.com/1424-8247/18/6/800 |
| work_keys_str_mv | AT samerwahood fluoroquinolonesfordermatologistsapracticalguidetoclinicaluseandriskmanagement AT omaralani fluoroquinolonesfordermatologistsapracticalguidetoclinicaluseandriskmanagement AT iyladraw fluoroquinolonesfordermatologistsapracticalguidetoclinicaluseandriskmanagement AT larashqair fluoroquinolonesfordermatologistsapracticalguidetoclinicaluseandriskmanagement AT davidwang fluoroquinolonesfordermatologistsapracticalguidetoclinicaluseandriskmanagement AT christophergbunick fluoroquinolonesfordermatologistsapracticalguidetoclinicaluseandriskmanagement AT giovannidamiani fluoroquinolonesfordermatologistsapracticalguidetoclinicaluseandriskmanagement AT jonathandho fluoroquinolonesfordermatologistsapracticalguidetoclinicaluseandriskmanagement AT sabineobagi fluoroquinolonesfordermatologistsapracticalguidetoclinicaluseandriskmanagement AT hosseinakbarialiabad fluoroquinolonesfordermatologistsapracticalguidetoclinicaluseandriskmanagement AT fabriziogalimberti fluoroquinolonesfordermatologistsapracticalguidetoclinicaluseandriskmanagement AT mahmoudghannoum fluoroquinolonesfordermatologistsapracticalguidetoclinicaluseandriskmanagement AT aymangrada fluoroquinolonesfordermatologistsapracticalguidetoclinicaluseandriskmanagement |