Fluoroquinolone options: ciprofloxacin, levofloxacin, moxifloxacin and what to pick

Fluoroquinolones are powerful oral antibiotics used for a range of infections. They work well against many bacteria, but they also carry real risks and growing resistance. This guide breaks down the common options, the problems to watch for, and practical alternatives so you can talk to your doctor with confidence.

Common fluoroquinolones and when they’re used

Ciprofloxacin (often called Ciplox) — a go-to for urinary tract infections, certain gastrointestinal infections, and some skin or soft tissue infections. It reaches high levels in urine and gut, which makes it useful for those sites.

Levofloxacin — used more for respiratory infections like community-acquired pneumonia, sinusitis, and complicated bronchitis. It has better lung penetration than ciprofloxacin.

Moxifloxacin — strong for respiratory bugs and some atypical organisms. It’s less ideal for uncomplicated UTIs because it doesn’t concentrate in urine as well.

Ofloxacin and norfloxacin are older options still seen in some places. Choice often depends on the likely bacteria, site of infection, and local resistance patterns.

Risks, resistance, and real alternatives

Fluoroquinolones can cause tendon damage (including rupture), nerve pain or weakness (peripheral neuropathy), mood or sleep changes, and possible heart rhythm effects (QT prolongation). They’re usually avoided in pregnancy and young children unless necessary. Because of these risks, many guidelines limit their routine use.

Resistance is rising worldwide. In some regions, common bugs no longer respond well to fluoroquinolones, so labs and local resistance data matter. Before choosing one, clinicians consider the infection site, severity, patient age, kidney function, and other meds that can interact (for example, antacids and supplements with calcium, iron or magnesium reduce absorption).

Safer or more appropriate alternatives depend on the infection. For mild respiratory infections, amoxicillin or doxycycline may work. For skin infections, certain cephalosporins or clindamycin are options. For some STIs or GI infections, macrolides (like azithromycin) or targeted treatments may be better. Always base the choice on culture results when possible.

How doctors pick: they balance likely bacteria, drug levels at the infection site, allergy history, side-effect risks, and local antibiotic resistance. Shorter courses are often as effective and lower side-effect risk when appropriate.

Practical tips for patients: tell your doctor about tendon or nerve pain immediately; avoid antacids or mineral supplements two hours before or after taking these drugs; finish the prescribed course unless told otherwise; and never buy antibiotics without a prescription. If ordering online, use a licensed pharmacy that asks for a valid prescription.

Quick checklist before starting a fluoroquinolone: is the infection severe or drug-resistant? Are there safer alternatives? Any history of tendon problems or heart rhythm issues? Can a culture guide therapy? Ask these questions and get clear answers from your prescriber.