Fluoroquinolones and the risk for incidental seizures: a comparative retrospective study.

This article examines the incidence and risk of seizures associated with fluoroquinolones (FQ)—a class of broad-spectrum antibiotics including ofloxacin, ciprofloxacin, levofloxacin, and moxifloxacin—compared to macrolides (MA: azithromycin and roxithromycin) among hospitalized patients. In a retrospective observational study of over 52,000 patients treated with FQ and 8,500 treated with MA at a large tertiary academic medical center from 2009 to 2021, seizures occurred in 0.06% of FQ-treated patients and 0.07% of MA-treated patients, with no statistically significant difference in seizure risk after adjusting for confounders using propensity score matching and inverse probability weighting. Causality assessment using the Naranjo scale indicated probable or possible links between FQ and seizures in some cases, but overall the study found that FQ use was not associated with a higher seizure risk than macrolides. These findings provide evidence to inform clinicians and policymakers when weighing the risks and benefits of fluoroquinolone use in hospitalized adults.