{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T18:14:37Z","timestamp":1793297677932,"version":"4.5.0"},"reference-count":112,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T00:00:00Z","timestamp":1748217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Background: Fluoroquinolones, available in topical and oral formulations, are used to manage bacterial skin and soft tissue infections, including Pseudomonas aeruginosa, 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. Methods: 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 \u201cskin and soft tissue infection\u201d OR \u201cskin structure infection\u201d). Abstracts and presentations were excluded. A Google search used the same terms for articles from government regulatory agencies. Results: 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 Escherichia coli and P. aeruginosa in some populations. Culture-based prescribing, shorter treatment courses, and preference for topical treatments can reduce risk and preserve efficacy. Conclusions: 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.<\/jats:p>","DOI":"10.3390\/ph18060800","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T04:46:38Z","timestamp":1748493998000},"page":"800","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Fluoroquinolones for Dermatologists: A Practical Guide to Clinical Use and Risk Management"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2216-1975","authenticated-orcid":false,"given":"Samer","family":"Wahood","sequence":"first","affiliation":[{"name":"The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Alani","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iyla","family":"Draw","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Louisville School of Medicine, Louisville, KY 40202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Shqair","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3071-1265","authenticated-orcid":false,"given":"David","family":"Wang","sequence":"additional","affiliation":[{"name":"Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02118, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4011-8308","authenticated-orcid":false,"given":"Christopher G.","family":"Bunick","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Program in Translational Biomedicine, Yale School of Medicine, New Haven, CT 06520, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2390-6505","authenticated-orcid":false,"given":"Giovanni","family":"Damiani","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan D.","family":"Ho","sequence":"additional","affiliation":[{"name":"Departments of Dermatology and Pathology, The University of the West Indies, Mona Campus, Kingston 7, Jamaica"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Obagi","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Arizona College of Medicine, Tucson, AZ 85724, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hossein","family":"Akbarialiabad","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Galimberti","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Conway Medical Center, Conway, SC 29526, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Ghannoum","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5321-0584","authenticated-orcid":false,"given":"Ayman","family":"Grada","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Naeem, A., Badshah, S.L., Muska, M., Ahmad, N., and Khan, K. (2016). The Current Case of Quinolones: Synthetic Approaches and Antibacterial Activity. Molecules, 21.","DOI":"10.3390\/molecules21040268"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S19","DOI":"10.1093\/clinids\/23.Supplement_1.S19","article-title":"Pharmacokinetics and Pharmacodynamics of Newer Fluoroquinolones","volume":"23","author":"Stein","year":"1996","journal-title":"Clin. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1517\/14656566.5.2.237","article-title":"The Use of Fluoroquinolones in the Treatment of Skin Infections","volume":"5","author":"Martin","year":"2004","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1517\/14740338.2013.796362","article-title":"Risks Associated with the Therapeutic Use of Fluoroquinolones","volume":"12","author":"Stahlmann","year":"2013","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/S0924-8579(00)00192-8","article-title":"The Fluoroquinolone Antibacterials: Past, Present and Future Perspectives","volume":"16","author":"Appelbaum","year":"2000","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/S0149-2918(00)88266-1","article-title":"Expanded Activity and Utility of the New Fluoroquinolones: A Review","volume":"21","author":"Blondeau","year":"1999","journal-title":"Clin. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"37","DOI":"10.2165\/00128071-200203010-00004","article-title":"The Role of Fluoroquinolones in Skin and Skin Structure Infections","volume":"3","author":"Blondeau","year":"2002","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"82","DOI":"10.2165\/00003495-199958002-00016","article-title":"Fluoroquinolone Treatment of Skin and Skin Structure Infections","volume":"58","author":"Karchmer","year":"1999","journal-title":"Drugs"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S213","DOI":"10.1093\/cid\/ciy1079","article-title":"Profile of a Novel Anionic Fluoroquinolone-Delafloxacin","volume":"68","author":"Tulkens","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e00772-17","DOI":"10.1128\/AAC.00772-17","article-title":"In Vitro Activity of Delafloxacin and Microbiological Response against Fluoroquinolone-Susceptible and Nonsusceptible Staphylococcus aureus Isolates from Two Phase 3 Studies of Acute Bacterial Skin and Skin Structure Infections","volume":"61","author":"McCurdy","year":"2017","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1517\/13543784.2015.1005205","article-title":"Delafloxacin for the Treatment of Respiratory and Skin Infections","volume":"24","author":"Bassetti","year":"2015","journal-title":"Expert Opin. Investig. Drugs"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1007\/s40265-020-01358-0","article-title":"Delafloxacin: A Review in Acute Bacterial Skin and Skin Structure Infections","volume":"80","author":"Scott","year":"2020","journal-title":"Drugs"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1093\/jac\/dkx543","article-title":"Clinical Review of Delafloxacin: A Novel Anionic Fluoroquinolone","volume":"73","author":"Mogle","year":"2018","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"6","DOI":"10.2165\/00003495-199958002-00002","article-title":"Mode of Action of Fluoroquinolones","volume":"58","author":"Hooper","year":"1999","journal-title":"Drugs"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S24","DOI":"10.1086\/314056","article-title":"Mechanisms of Action and Resistance of Older and Newer Fluoroquinolones","volume":"31","author":"Hooper","year":"2000","journal-title":"Clin. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.1086\/319370","article-title":"Mechanisms of Action of Antimicrobials: Focus on Fluoroquinolones","volume":"32","author":"Hooper","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Bush, N.G., Diez-Santos, I., Abbott, L.R., and Maxwell, A. (2020). Quinolones: Mechanism, Lethality and Their Contributions to Antibiotic Resistance. Molecules, 25.","DOI":"10.3390\/molecules25235662"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1128\/AAC.02299-15","article-title":"Reactive Oxygen Species Contribute to the Bactericidal Effects of the Fluoroquinolone Moxifloxacin in Streptococcus pneumoniae","volume":"60","author":"Arnanz","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1093\/jac\/dkz485","article-title":"Reactive Oxygen Species Play a Dominant Role in All Pathways of Rapid Quinolone-Mediated Killing","volume":"75","author":"Hong","year":"2020","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1086\/381972","article-title":"Clinical Relevance of Bacteriostatic versus Bactericidal Mechanisms of Action in the Treatment of Gram-Positive Bacterial Infections","volume":"38","author":"Pankey","year":"2004","journal-title":"Clin. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.tim.2014.04.007","article-title":"Fluoroquinolone Resistance: Mechanisms, Impact on Bacteria, and Role in Evolutionary Success","volume":"22","author":"Redgrave","year":"2014","journal-title":"Trends Microbiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"29","DOI":"10.2165\/00003495-199958002-00006","article-title":"Pharmacokinetics and Pharmacodynamics of Fluoroquinolones","volume":"58","author":"Turnidge","year":"1999","journal-title":"Drugs"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"233S","DOI":"10.1592\/phco.21.16.233S.33992","article-title":"Pharmacokinetics and Pharmacodynamics of Fluoroquinolones","volume":"21","author":"Rodvold","year":"2001","journal-title":"Pharmacotherapy"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"169","DOI":"10.2165\/00003088-200140030-00003","article-title":"Comparative Pharmacokinetics and Pharmacodynamics of the Newer Fluoroquinolone Antibacterials","volume":"40","author":"Aminimanizani","year":"2001","journal-title":"Clin. Pharmacokinet."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3129","DOI":"10.1517\/14656560802489262","article-title":"Ciprofloxacin 0.3%\/Dexamethasone 0.1% Topical Drops for the Management of Otic Infections","volume":"9","author":"Roland","year":"2008","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1111\/j.1574-695X.2010.00755.x","article-title":"Levofloxacin Reduces Inflammatory Cytokine Levels in Human Bronchial Epithelia Cells: Implications for Aerosol MP-376 (Levofloxacin Solutionfor Inhalation) Treatment of Chronic Pulmonary Infections","volume":"61","author":"Tsivkovskii","year":"2011","journal-title":"FEMS Immunol. Med. Microbiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1186\/s12974-019-1538-9","article-title":"Ciprofloxacin and Levofloxacin Attenuate Microglia Inflammatory Response via TLR4\/NF-kB Pathway","volume":"16","author":"Zusso","year":"2019","journal-title":"J. Neuroinflamm."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/S1473-3099(03)00658-3","article-title":"Immunomodulatory Effects of Quinolones","volume":"3","author":"Dalhoff","year":"2003","journal-title":"Lancet Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"9328","DOI":"10.62754\/joe.v3i8.5546","article-title":"Ciprofloxacin: An Overview of Uses, Mechanism of Action, and Adverse Effects","volume":"3","author":"Almutairi","year":"2024","journal-title":"J. Ecohumanism"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1093\/cid\/ciu444","article-title":"Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America","volume":"59","author":"Stevens","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"ciae403","DOI":"10.1093\/cid\/ciae403","article-title":"Infectious Diseases Society of America 2024 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections","volume":"79","author":"Tamma","year":"2024","journal-title":"Clin. Infect. Dis."},{"key":"ref_32","unstructured":"Brown, B.D., and Hood Watson, K.L. (2025). Cellulitis. StatPearls, StatPearls Publishing."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"309","DOI":"10.2147\/tcrm.2007.3.2.309","article-title":"Skin and Skin Structure Infections: Treatment with Newer Generation Fluoroquinolones","volume":"3","author":"Giordano","year":"2007","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_34","unstructured":"Nardi, N.M., and Schaefer, T.J. (2025). Impetigo. StatPearls, StatPearls Publishing."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1590\/abd1806-4841.20164860","article-title":"Staphylococcus aureus Resistance to Topical Antimicrobials in Atopic Dermatitis","volume":"91","author":"Bessa","year":"2016","journal-title":"An. Bras. Dermatol."},{"key":"ref_36","unstructured":"United States Food and Drug Administration (2025, April 12). XEPI\u2122 (Ozenoxacin) Cream, for Topical Use, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2017\/208945lbl.pdf."},{"key":"ref_37","first-page":"655","article-title":"Topical Ozenoxacin Cream 1% for Impetigo: A Review","volume":"18","author":"Schachner","year":"2019","journal-title":"J. Drugs Dermatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1067\/mjd.2001.114747","article-title":"Gram-Negative Bacterial Toe Web Infection: A Survey of 123 Cases from the District of Cagliari, Italy","volume":"45","author":"Aste","year":"2001","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1111\/1346-8138.15832","article-title":"Clinical Analysis of Pseudomonas aeruginosa-Positive and -Negative Green Nail Syndrome Cases: A Single Center Retrospective Analysis","volume":"48","author":"Lee","year":"2021","journal-title":"J. Dermatol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1159\/000365863","article-title":"Green Nail Syndrome (Pseudomonas aeruginosa Nail Infection): Two Cases Successfully Treated with Topical Nadifloxacin, an Acne Medication","volume":"6","author":"Itin","year":"2014","journal-title":"Case Rep. Dermatol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"ofae258","DOI":"10.1093\/ofid\/ofae258","article-title":"Antipseudomonal Antibiotics in Diabetic Foot Infections: A Practical Perspective From a Community Hospital","volume":"11","author":"Lau","year":"2024","journal-title":"Open Forum Infect. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1086\/497143","article-title":"Practice Guidelines for the Diagnosis and Management of Skin and Soft-Tissue Infections","volume":"41","author":"Stevens","year":"2005","journal-title":"Clin. Infect. Dis."},{"key":"ref_43","first-page":"71","article-title":"Diabetic Foot Infection","volume":"78","author":"Bader","year":"2008","journal-title":"Am. Fam. Physician Afp"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"3133","DOI":"10.1128\/AAC.44.11.3133-3136.2000","article-title":"Antibiotic Susceptibility Pattern of Mycobacterium marinum","volume":"44","author":"Aubry","year":"2000","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2345","DOI":"10.2147\/IDR.S180283","article-title":"Pseudomonas aeruginosa Bacteremia among Liver Transplant Recipients","volume":"11","author":"Liu","year":"2018","journal-title":"Infect. Drug Resist."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/978-3-031-04402-1_1","article-title":"Fluoroquinolone-Associated Disability and Other Fluoroquinolone-Associated Serious Adverse Events: Unexpected Toxicities Have Emerged in Recent Years","volume":"Volume 184","author":"Bennett","year":"2022","journal-title":"Cancer Drug Safety and Public Health Policy"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"265","DOI":"10.36849\/JDD.7345","article-title":"Trends in Oral Antibiotic Use for Acne Treatment: A Retrospective, Population-Based Study in the United States, 2014 to 2016","volume":"22","author":"Grada","year":"2023","journal-title":"J. Drugs Dermatol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.det.2015.08.013","article-title":"Antibiotic Treatment of Hidradenitis Suppurativa","volume":"34","author":"Bettoli","year":"2016","journal-title":"Dermatol. Clin."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.1111\/bjd.15739","article-title":"Oral Ofloxacin and Clindamycin as an Alternative to the Classic Rifampicin-Clindamycin in Hidradenitis Suppurativa: Retrospective Analysis of 65 Patients","volume":"178","author":"Delaunay","year":"2018","journal-title":"Br. J. Dermatol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1086\/375078","article-title":"Fluoroquinolone-Associated Tendinopathy: A Critical Review of the Literature","volume":"36","author":"Khaliq","year":"2003","journal-title":"Clin. Infect. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1228.e23","DOI":"10.1016\/j.amjmed.2012.05.027","article-title":"Impact of Age, Sex, Obesity, and Steroid Use on Quinolone-Associated Tendon Disorders","volume":"125","author":"Wise","year":"2012","journal-title":"Am. J. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.tox.2005.04.002","article-title":"Fluoroquinolones Cause Changes in Extracellular Matrix, Signalling Proteins, Metalloproteinases and Caspase-3 in Cultured Human Tendon Cells","volume":"212","author":"Sendzik","year":"2005","journal-title":"Toxicology"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1111\/j.1440-1673.2005.01470.x","article-title":"Achilles Tendinopathy after Treatment with Fluoroquinolone","volume":"49","author":"Yu","year":"2005","journal-title":"Australas. Radiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.amjopharm.2008.11.002","article-title":"An Elderly Patient with Fluoroquinolone-Associated Achilles Tendinitis","volume":"6","author":"Damuth","year":"2008","journal-title":"Am. J. Geriatr. Pharmacother."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1056\/NEJM199409153311116","article-title":"Achilles Tendinitis and Tendon Rupture Due to Fluoroquinolone Antibiotics","volume":"331","author":"Huston","year":"1994","journal-title":"N. Engl. J. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1038\/nature04710","article-title":"hERG Potassium Channels and Cardiac Arrhythmia","volume":"440","author":"Sanguinetti","year":"2006","journal-title":"Nature"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/j.jacc.2010.01.001","article-title":"Prevention of Torsade de Pointes in Hospital Settings: A Scientific Statement from the American Heart Association and the American College of Cardiology Foundation","volume":"55","author":"Drew","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1097\/EDE.0b013e318225768b","article-title":"Electrocardiographic QT Interval and Mortality: A Meta-Analysis","volume":"22","author":"Zhang","year":"2011","journal-title":"Epidemiology"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.psym.2012.11.001","article-title":"QTc Prolongation, Torsades de Pointes, and Psychotropic Medications","volume":"54","author":"Beach","year":"2013","journal-title":"Psychosomatics"},{"key":"ref_60","first-page":"2120","article-title":"What Clinicians Should Know about the QT Interval","volume":"289","author":"LaPointe","year":"2003","journal-title":"JAMA"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1111\/j.1751-1097.1998.tb05217.x","article-title":"Fluoroquinolone Antimicrobials: Singlet Oxygen, Superoxide and Phototoxicity","volume":"67","author":"Sik","year":"1998","journal-title":"Photochem. Photobiol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"3719","DOI":"10.4049\/jimmunol.160.8.3719","article-title":"Cross-Reactivity in Murine Fluoroquinolone Photoallergy: Exclusive Usage of TCR V\u03b213 by Immune T Cells That Recognize Fluoroquinolone-Photomodified Cells","volume":"160","author":"Tokura","year":"1998","journal-title":"J. Immunol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1111\/j.1365-2133.2003.05582.x","article-title":"A Randomized Controlled Trial (Volunteer Study) of Sitafloxacin, Enoxacin, Levofloxacin and Sparfloxacin Phototoxicity","volume":"149","author":"Dawe","year":"2003","journal-title":"Br. J. Dermatol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"37","DOI":"10.2165\/00003495-199958002-00007","article-title":"Toxicity of Quinolones","volume":"58","author":"Stahlmann","year":"1999","journal-title":"Drugs"},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Kowalska, J., Banach, K., Rok, J., Beberok, A., Rzepka, Z., and Wrze\u015bniok, D. (2020). Molecular and Biochemical Basis of Fluoroquinolones-Induced Phototoxicity\u2014The Study of Antioxidant System in Human Melanocytes Exposed to UV-A Radiation. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21249714"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1345\/aph.1K347","article-title":"Safety Concerns with Fluoroquinolones","volume":"41","author":"Mehlhorn","year":"2007","journal-title":"Ann. Pharmacother."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1007\/s40264-019-00806-5","article-title":"Drug-Induced Photosensitivity-An Update: Culprit Drugs, Prevention and Management","volume":"42","author":"Blakely","year":"2019","journal-title":"Drug Saf."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Xie, W.-L., Ge, M.-L., Chen, D., Chen, G.-Q., Mei, Y.-X., and Lai, Y.-J. (2024). Psychiatric Disorders Associated with Fluoroquinolones: A Pharmacovigilance Analysis of the FDA Adverse Event Reporting System Database. Front. Pharmacol., 15.","DOI":"10.3389\/fphar.2024.1435923"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"235","DOI":"10.3390\/neurosci2030017","article-title":"Fluoroquinolones-Associated Disability: It Is Not All in Your Head","volume":"2","author":"Freeman","year":"2021","journal-title":"NeuroSci"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1086\/600294","article-title":"Severe Dysglycemia with the Fluoroquinolones: A Class Effect?","volume":"49","author":"Aspinall","year":"2009","journal-title":"Clin. Infect. Dis."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.ejphar.2004.06.032","article-title":"Effects of Fluoroquinolones on Insulin Secretion and \u03b2-Cell ATP-Sensitive K+ Channels","volume":"497","author":"Saraya","year":"2004","journal-title":"Eur. J. Pharmacol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1111\/j.1476-5381.1996.tb15201.x","article-title":"Increase in Insulin Release from Rat Pancreatic Islets by Quinolone Antibiotics","volume":"117","author":"Maeda","year":"1996","journal-title":"Br. J. Pharmacol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1093\/jac\/dkg370","article-title":"Gatifloxacin and the Elderly: Pharmacokinetic-Pharmacodynamic Rationale for a Potential Age-Related Dose Reduction","volume":"52","author":"Ambrose","year":"2003","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1001\/jamasurg.2020.6165","article-title":"Association of Fluoroquinolone Use with Short-Term Risk of Development of Aortic Aneurysm","volume":"156","author":"Newton","year":"2021","journal-title":"JAMA Surg."},{"key":"ref_75","unstructured":"FDA Center for Drug Evaluation and Research (2025, April 11). FDA Warns about Increased Risk of Ruptures or Tears in the Aorta Blood Vessel with Fluoroquinolone Antibiotics in Certain Patients, Available online: https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-warns-about-increased-risk-ruptures-or-tears-aorta-blood-vessel-fluoroquinolone-antibiotics."},{"key":"ref_76","unstructured":"FDA Center for Drug Evaluation and Research (2025, March 01). Fluoroquinolone Antimicrobial Drugs Information, Available online: https:\/\/www.fda.gov\/drugs\/information-drug-class\/fluoroquinolone-antimicrobial-drugs-information."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"889","DOI":"10.2165\/00002018-200629100-00006","article-title":"Evidence of Tendinitis Provoked by Fluoroquinolone Treatment: A Case-Control Study","volume":"29","author":"Corrao","year":"2006","journal-title":"Drug Saf."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1001\/jamaneurol.2019.0887","article-title":"Association Between Peripheral Neuropathy and Exposure to Oral Fluoroquinolone or Amoxicillin-Clavulanate Therapy","volume":"76","author":"Morales","year":"2019","journal-title":"JAMA Neurol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"105038","DOI":"10.1016\/j.cmicom.2024.105038","article-title":"Examining Hypoglycemia Risk with Systemic Fluoroquinolone Use: A Systematic Review and Meta-Analysis","volume":"1","author":"Guo","year":"2024","journal-title":"CMI Commun."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1016\/j.amjmed.2009.07.022","article-title":"Quinolone-Induced Hypoglycemia: A Life-Threatening but Potentially Reversible Side Effect","volume":"123","author":"Kelesidis","year":"2010","journal-title":"Am. J. Med."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"e0070821","DOI":"10.1128\/AAC.00708-21","article-title":"Fluoroquinolone Prescribing for Diabetic Foot Infections Following an FDA Drug Safety Communication for Aortic Aneurysm Risk","volume":"65","author":"Li","year":"2021","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/01.JAA.0000873776.37967.9b","article-title":"A Preventable, Life-Altering Case of Fluoroquinolone-Associated Tendonitis","volume":"35","author":"Wildermuth","year":"2022","journal-title":"JAAPA"},{"key":"ref_83","unstructured":"Farzam, K., and Tivakaran, V.S. (2025). QT Prolonging Drugs. StatPearls, StatPearls Publishing."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Shu, Y., Zhang, Q., He, X., Liu, Y., Wu, P., and Chen, L. (2022). Fluoroquinolone-Associated Suspected Tendonitis and Tendon Rupture: A Pharmacovigilance Analysis from 2016 to 2021 Based on the FAERS Database. Front. Pharmacol., 13.","DOI":"10.3389\/fphar.2022.990241"},{"key":"ref_85","first-page":"e61174","article-title":"Fluoroquinolone-Induced Multisystem Toxicity: A Case Report","volume":"16","author":"Landers","year":"2024","journal-title":"Cureus"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"8023935","DOI":"10.1155\/2017\/8023935","article-title":"Treatment of the Fluoroquinolone-Associated Disability: The Pathobiochemical Implications","volume":"2017","author":"Michalak","year":"2017","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_87","unstructured":"(2025, March 01). Outpatient Antibiotic Prescriptions\u2014United States, 2022|Antibiotic Use|CDC, Available online: https:\/\/archive.cdc.gov\/www_cdc_gov\/antibiotic-use\/data\/report-2022.html."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1001\/jamadermatol.2018.4944","article-title":"Trends in Oral Antibiotic Prescription in Dermatology, 2008 to 2016","volume":"155","author":"Barbieri","year":"2019","journal-title":"JAMA Dermatol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1001\/jamadermatol.2022.3168","article-title":"Antibiotic Stewardship in Dermatology: Reducing the Risk of Prolonged Antimicrobial Resistance in Skin","volume":"158","author":"MacGibeny","year":"2022","journal-title":"JAMA Dermatol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"e195","DOI":"10.1016\/j.jaad.2022.07.056","article-title":"Comment on: Antibiotic Resistance in Dermatology: The Scope of the Problem and Strategies to Address It","volume":"87","author":"Rengarajan","year":"2022","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1093\/cid\/ciy1102","article-title":"The Association of Antibiotic Stewardship with Fluoroquinolone Prescribing in Michigan Hospitals: A Multi-Hospital Cohort Study","volume":"69","author":"Vaughn","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1016\/j.ajic.2019.01.026","article-title":"Impact of Syndrome-Specific Antimicrobial Stewardship Interventions on Use of and Resistance to Fluoroquinolones: An Interrupted Time Series Analysis","volume":"47","author":"Hecker","year":"2019","journal-title":"Am. J. Infect. Control"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1017\/ice.2019.247","article-title":"Impact of FDA Black Box Warning on Fluoroquinolone and Alternative Antibiotic Use in Southeastern US Hospitals","volume":"40","author":"Yarrington","year":"2019","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Grada, A., Ghannoum, M.A., and Bunick, C.G. (2022). Sarecycline Demonstrates Clinical Effectiveness against Staphylococcal Infections and Inflammatory Dermatoses: Evidence for Improving Antibiotic Stewardship in Dermatology. Antibiotics, 11.","DOI":"10.3390\/antibiotics11060722"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"193","DOI":"10.2165\/11531490-000000000-00000","article-title":"Safety Considerations of Fluoroquinolones in the Elderly: An Update","volume":"27","author":"Stahlmann","year":"2010","journal-title":"Drugs Aging"},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Rusu, A., Munteanu, A.-C., Arb\u0103na\u0219i, E.-M., and Uivarosi, V. (2023). Overview of Side-Effects of Antibacterial Fluoroquinolones: New Drugs versus Old Drugs, a Step Forward in the Safety Profile?. Pharmaceutics, 15.","DOI":"10.3390\/pharmaceutics15030804"},{"key":"ref_97","unstructured":"Werth, B.J. (2025, March 01). Fluoroquinolones\u2014Infectious Diseases. Available online: https:\/\/www.merckmanuals.com\/professional\/infectious-diseases\/bacteria-and-antibacterial-medications\/fluoroquinolones."},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Kimberlin, D.W., Barnett, E.D., Lynfield, R., and Sawyer, M.H. (2021). Fluoroquinolones. Red Book: 2021\u20132024 Report of the Committee on Infectious Diseases, American Academy of Pediatrics.","DOI":"10.1542\/9781610025225"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"3399","DOI":"10.21037\/jtd-20-2256","article-title":"Fluoroquinolone and No Risk of Achilles-Tendinopathy in Childhood Pneumonia under Eight Years of Age\u2014A Nationwide Retrospective Cohort","volume":"13","author":"Kim","year":"2021","journal-title":"J. Thorac. Dis."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"37S","DOI":"10.1016\/0002-9343(89)90018-1","article-title":"Ciprofloxacin: Toxicologic Evaluation of Additional Safety Data","volume":"87","author":"Schluter","year":"1989","journal-title":"Am. J. Med."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/0002-9343(87)90614-0","article-title":"Norfloxacin: Review of Safety Studies","volume":"82","author":"Corrado","year":"1987","journal-title":"Am. J. Med."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1128\/AAC.42.6.1336","article-title":"Pregnancy Outcome Following Gestational Exposure to Fluoroquinolones: A Multicenter Prospective Controlled Study","volume":"42","author":"Loebstein","year":"1998","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"4392","DOI":"10.1128\/AAC.02413-14","article-title":"Observational Cohort Study of Pregnancy Outcome after First-Trimester Exposure to Fluoroquinolones","volume":"58","author":"Padberg","year":"2014","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1093\/jac\/31.4.457","article-title":"Antagonism of GABAA Receptors by 4-Quinolones","volume":"31","author":"Halliwell","year":"1993","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.1111\/jgs.13039","article-title":"Levofloxacin and Seizures: What Risk for Elderly Adults?","volume":"62","author":"Famularo","year":"2014","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_106","unstructured":"United States Food and Drug Administration (2025, April 12). CIPRO (Ciprofloxacin Hydrochloride), Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/Label\/2016\/019537s086lbl.pdf."},{"key":"ref_107","unstructured":"United States Food and Drug Administration (2025, April 12). AVELOX (Moxifloxacin Hydrochloride), Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2016\/021085s063lbl.pdf."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"e180","DOI":"10.1017\/ash.2022.316","article-title":"Characterizing Barriers to Antibiotic Stewardship for Skin and Soft-Tissue Infections in the Emergency Department Using a Systems Engineering Framework","volume":"2","author":"Pulia","year":"2022","journal-title":"Antimicrob. Steward. Healthc. Epidemiol."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"iv9","DOI":"10.1093\/jac\/dkab351","article-title":"Current and Future Options for Treating Complicated Skin and Soft Tissue Infections: Focus on Fluoroquinolones and Long-Acting Lipoglycopeptide Antibiotics","volume":"76","author":"Eckmann","year":"2021","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_110","doi-asserted-by":"crossref","unstructured":"Geremia, N., Giovagnorio, F., Colpani, A., De Vito, A., Botan, A., Stroffolini, G., Toc, D.-A., Zerbato, V., Principe, L., and Madeddu, G. (2024). Fluoroquinolones and Biofilm: A Narrative Review. Pharmaceuticals, 17.","DOI":"10.3390\/ph17121673"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"S97","DOI":"10.1093\/cid\/ciu542","article-title":"Core Elements of Hospital Antibiotic Stewardship Programs From the Centers for Disease Control and Prevention","volume":"59","author":"Pollack","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_112","doi-asserted-by":"crossref","unstructured":"Stocco, G., Lucaf\u00f2, M., and Decorti, G. (2020). Pharmacogenomics of Antibiotics. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21175975"}],"container-title":["Pharmaceuticals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8247\/18\/6\/800\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:40:58Z","timestamp":1760031658000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8247\/18\/6\/800"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,26]]},"references-count":112,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["ph18060800"],"URL":"https:\/\/doi.org\/10.3390\/ph18060800","relation":{},"ISSN":["1424-8247"],"issn-type":[{"value":"1424-8247","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,26]]}}}