Fluoroquinolone Neuropathy Risk Comparable to Cephalosporins

Findings did not indicate a substantive difference in the risk of incident peripheral neuropathy within 60 days between adults prescribed systemic fluoroquinolones and those prescribed cephalosporins, according to a cohort study published in Neurology.

The investigators analyzed UK primary care records from the Clinical Practice Research Datalink (CPRD) Aurum and GOLD databases from April 1997 to December 2019. They included adults without diabetes or previously recorded peripheral neuropathy who were prescribed systemic fluoroquinolones or cephalosporins: 2,933,982 in Aurum (median age, 49.5 years; 63.7% female) and 995,457 in GOLD (median age, 51.5 years; 63.5% female). At the first treatment episode, 34.2% and 38.3%, respectively, were prescribed fluoroquinolones. Hazard ratios were estimated using stabilized inverse probability of treatment weighting and pooled across the 2 databases.

The association between fluoroquinolones and peripheral neuropathy was close to the null at the first treatment episode (pooled adjusted hazard ratio [aHR], 0.96; 95% CI, 0.77-1.20) and over all treatment episodes (pooled aHR, 1.05). By contrast, hazard ratios were elevated for tendon rupture, which served as a positive control outcome, at the first treatment episode (pooled aHR, 1.98) and over all episodes (pooled aHR, 1.76).

The authors noted potential residual confounding as a limitation. They said the results provide some reassurance to clinicians regarding the risk of peripheral neuropathy with fluoroquinolones relative to a comparator antibiotic.

Source: Brown JP, Wing K, Mansfield KE, et al. Association between systemic fluoroquinolones and risk of peripheral neuropathy. Neurology. 2026;107(10):e218699. doi:10.1212/WNL.0000000000218699