As an internal medicine resident and pulmonary/critical care fellow, I loved fluoroquinolones. They were effective, easy to prescribe, and had 100% oral bioavailability. However, working full-time in the ICU has forced me to realize that these drugs aren’t so wonderful for the critically ill. Ironically, the advantages of fluoroquinolones have also been their Achilles’ heel (no pun intended). Fluoroquinolones are the #1 most commonly used antibiotics among outpatient prescribers, administered broadly for anything from diverticulitis to the common cold. In fairness, fluoroquinolones are generally very effective and toxicity is uncommon. In situations where fluoroquinolones are the best antibiotic choice, they should certainly be used.

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