Fluoroquinolone Prescribing in Primary Care: Patient Safety, Antimicrobial Stewardship and Forensic Implications Under the Italian Framework—A Narrative Review

Fluoroquinolones remain widely prescribed in primary care although regulators have restricted their use because of rare but serious, potentially disabling and irreversible adverse reactions. This narrative review, based on a PubMed search (2008–2026) and regulatory and Italian legal sources, examines fluoroquinolone safety, prescribing patterns and forensic implications from a general-practice and legal-medicine perspective. The evidence behind regulatory warnings is uneven: tendon and aortic events have the strongest observational support, other associations remain uncertain, and absolute risks are low. The US Food and Drug Administration and the European Medicines Agency advise against fluoroquinolones for mild or self-limiting infections when alternatives exist, yet US, European and Italian data show persistent use, particularly for uncomplicated cystitis. The forensic analysis is limited to the Italian framework (Laws no. 24/2017 and no. 219/2017) and cannot be generalised to other jurisdictions: prescribing that departs from the product information or from guidelines is not in itself negligent, and liability depends on the individual case, clinical reasoning, information given and documentation. General practitioners and pharmacist-led stewardship, prescription review and patient counselling can support appropriate use. Fluoroquinolones should be reserved for, not withheld from, patients in whom they are clinically indicated. A proposed, non-validated checklist for prescribing and documentation is provided.