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Fluoroquinolone prescribing in Wales was reduced by 35% between December 2023 and December 2024, according to a report published by the All-Wales Therapeutics and Toxicology Centre (AWTTC).
The report — ‘In focus report: 4C antimicrobials‘, published on 15 April 2026 — revealed that fluoroquinolone prescribing in Wales dropped from 21.6 defined daily doses (DDDs) per 1,000 patients in December 2023 to 14.0 DDDs per 1,000 patients by December 2024.
The AWTTC noted that “4C antimicrobials” refer to four classes of broad-spectrum antibiotics or antibiotic classes: co-amoxiclav, cephalosporins, fluoroquinolones and clindamycin.
The report also highlighted that fluoroquinolones accounted for 16% of 4C antimicrobial prescribing per 1,000 patients in Wales between the fourth quarter of 2022/2023 and the fourth quarter of 2024/2025.
It said the most common fluoroquinolones prescribed were ciprofloxacin (62%), ofloxacin (24%) and levofloxacin (13%), as of March 2025.
In January 2024, Medicines and Healthcare products Regulatory Agency (MHRA) drug safety update published a report that advised fluoroquinolones to only be prescribed when other antibiotics have failed, will not work owing to antibiotic resistance, or when they are deemed unsafe to use for an individual patient.
The advice was issued because systemic and inhaled fluoroquinolones are associated with a risk of serious, disabling, long-lasting and potentially irreversible adverse reactions in at least 1–10 people in every 10,000 people taking the drugs, the MHRA said.
Julie Harris, consultant pharmacist in antimicrobials at Swansea Bay University Health Board, commented: “Fluoroquinolones remain important antibiotics and continue to be the best option for some indications (e.g. ciprofloxacin) is the only oral option for pseudomonal infections. However, for many other indications, suitable alternatives do exist.
“This important risk/benefit assessment was supported in Wales by the All Wales Medicines Strategy Group antimicrobial primary care guidelines.
“Where quinolone prescribing is still indicated, then the guidelines promote use of the MHRA patient resources to ensure safe prescribing.”
She added: “The Welsh Antimicrobial Pharmacy Group (WAPG) have played a key role in supporting this work — both in the guideline review and through promoting those changes within the health board — to ensure prescribers are aware. The WAPG consists of antimicrobial pharmacists and technicians working across all of the Welsh health boards and Public Health Wales.
“This strong network of specialists has allowed collaborative work and sharing of best-practice that has helped get the messages out around quinolone prescribing in a consistent and effective way across Wales.”
Geraldine McCaffrey, director of the Royal College of Pharmacy in Wales, said: “The reduction of this scale in fluoroquinolone prescribing is a welcome and encouraging sign that updated guidance is being implemented effectively in practice.
“This reflects the hard work of those involved — particularly specialist antimicrobial pharmacists — whose expertise played a key role by leading the implementation of guidance and supporting system-wide behaviour change to ensure antibiotic use remained appropriate and safe.”
In a report published in 2025, the UK Health Security Agency revealed that a 32% decrease in overall fluoroquinolone use was seen in England between 2019 and 2024.
In 2025, the Scottish government sent a letter its colleagues, which set a target that by 2029, less than 3% of all antibiotics in primary care will be for co-amoxiclav and ciprofloxacin combined.
