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.

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.

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.”