Letters to the Editor

Fluoroquinolones for Sinusitis Should Be Used As a Last Resort


Am Fam Physician. 2017 Jun 15;95(12):757-758.

Original Article: Current Concepts in Adult Acute Rhinosinusitis

Issue Date: July 15, 2016

See additional reader comments at: https://www.aafp.org/afp/2016/0715/p97.html

to the editor: I am a family physician in New Hampshire, and I was recently disheartened by the article on adult acute rhinosinusitis, which implied that respiratory fluoroquinolones (moxifloxacin [Avelox] and levofloxacin [Levaquin]) were reasonable options as second-line therapy and alternatives to treat acute bacterial rhinosinusitis in patients allergic to penicillin. However, the U.S. Food and Drug Administration (FDA) has strongly cautioned against the use of fluoroquinolones in this context because of potentially life-threatening and permanent adverse effects from this class of medications.

The FDA advised “that the serious side effects associated with fluoroquinolone antibacterial drugs generally outweigh the benefits for patients with acute sinusitis, acute bronchitis, and uncomplicated urinary tract infections who have other treatment options. For patients with these conditions, fluoroquinolones should be reserved for those who do not have alternative treatment options. An FDA safety review has shown that fluoroquinolones when used systemically (i.e., tablets, capsules, and injectable) are associated with disabling and potentially permanent serious side effects that can occur together. These side effects can involve the tendons, muscles, joints, nerves, and central nervous system.”1

Several of my patients and family members have suffered significant harm and disability from the use of fluoroquinolones. Based on the FDA statement, this antibiotic class should be used as a last resort for the treatment of acute bacterial rhinosinusitis as opposed to a second-line therapy, as implied in the article.

Author disclosure: No relevant financial affiliations.


1. U.S. Food Drug Administration. FDA Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together. http://www.fda.gov/Drugs/DrugSafety/ucm500143.htm. Accessed July 29, 2016.

in reply: We thank Dr. Meek for his interest in our article on adult acute rhinosinusitis and for taking the time to comment. We agree with Dr. Meeks' important point that fluoroquinolones should not be routinely used to treat rhinosinusitis. The text of our article clearly stated that fluoroquinolones should be reserved for patients who do not have other treatment options. We appreciate the opportunity to clarify this important point.

Author disclosure: No relevant financial affiliations.

editor's note: For clarification, the following footnote has been added to the online version of Table 3: “Fluoroquinolones should be reserved for those who do not have alternative treatment options.”


Send letters to afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. Include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



Copyright © 2017 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


May 2022

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article