- Design
- Active-comparator cohort in two UK primary care databases, weighted Cox regression
- Population
- About 3.9 million adults without diabetes prescribed fluoroquinolones or cephalosporins
- Primary outcome
- Incident peripheral neuropathy within 60 days
- Effect
- Pooled aHR 0.96 (95% CI 0.77 to 1.20) first course; tendon rupture aHR 1.98 (1.55 to 2.53)
The researchers compared adults prescribed a fluoroquinolone with those prescribed a cephalosporin, using two UK primary care databases over two decades. They excluded people with diabetes or prior neuropathy.
Neuropathy risk was essentially the same in both groups. Tendon rupture, used as a positive control, was clearly raised with fluoroquinolones, which suggests the method could detect a real harm.
Neuropathy recorded in primary care may miss mild or short-lived symptoms, and the findings do not apply to people with diabetes. For most patients, the neuropathy warning should weigh less than the better-established harms.
- Neuropathy risk within 60 days was similar to cephalosporins (pooled HR 0.96 at first course).
- The expected tendon rupture signal appeared (HR 1.98), which supports the method.
- The study covered almost four million UK primary care patients.
- Fluoroquinolone restrictions for tendon, aortic and neuropsychiatric harms remain relevant.
Why it matters
Regulatory warnings on neuropathy rest largely on case reports, and this large comparison found no measurable excess.
Don't overread it
People with diabetes or existing neuropathy were excluded, and residual confounding is possible.
The statistics, in plain English
An HR of 0.96 with an interval from 0.77 to 1.20 crosses 1, so there is no evidence of excess risk. The positive control makes a false reassurance less likely.
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