A practice in the Buckinghamshire area

3. Mr B complains in June 2025, the Practice wrongly prescribed him ciprofloxacin, an antibiotic used to treat serious bacterial infections.

4. As a result, Mr B says the anxiety and stress he suffered as a result of learning about an associated Medicines and Healthcare products Regulator Agency (MHRA) warning and the risk of side effects led to him having a three week flare up of Crohn’s, a disease which caused digestive discomfort. He feels he is now at risk of further Crohn’s flare ups and is burdened with the stress of monitoring himself for potential side effects of ciprofloxacin.

5. As an outcome to his complaint, Mr B would like recognition the prescribing of ciprofloxacin was not appropriate and for the Practice to acknowledge the physical and psychological impact caused by the prescription. He would also like the Practice to work with its prescribing system provider to ensure MHRA warnings are integrated into the system.

6. In June 2025, Mr B attended the Practice for an urgent appointment due to severe abdominal pain. The Practice diagnosed him with a urinary tract infection (acute pyelonephritis) and prescribed ciprofloxacin.

7. Ciprofloxacin is an antibiotic. It belongs to a group of antibiotics called fluoroquinolones. It works by killing the bacteria that causes an infection.

8. Following this appointment, Mr B sought a second opinion. Subsequently, Mr B was diagnosed with a kidney stone and was advised to stop taking ciprofloxacin due to an MHRA warning.

12. In June 2025, Mr B attended an in-person out of hours GP appointment. At the time of his appointment, his symptoms had settled. He told his GP, due to his history of Crohn’s, he was concerned his pain was gastrointestinal in nature as by the time of the appointment the pain had settled following bowel movement. He presented his symptoms as severe left-sided abdominal pain, cloudy urine and visible blood.

13. As he was not confident with the GP’s diagnosis he attended a private consultation. At this consultation, he was told about the MHRA warning and advised to stop taking it immediately as antibiotics were not necessary. He was told it was likely a kidney stone linked to past stones, and to stay hydrated. A later CT scan confirmed this had cleared and no further treatment was required.

14. According to Mr B’s medical records, he presented with lower abdominal pain which had improved following bowel movement. He reported he was not in pain at the time of the appointment but it would come in waves. It is noted there was no testicular or scrotal pain but he had groin pain. The Practice carried out a urine test which confirmed positive leucocytes (white blood cells in urine).

15. Mr B was diagnosed with acute pyelonephritis, a type of urinary tract infection. Mr B was advised to drink plenty of fluids, take two paracetamol tablets every six hours and ciprofloxacin twice a day. Mr B was also advised to take a urine sample to his GP after treatment and to attend A&E if there was another bout of severe abdominal pain or other red flags such as not passing urine.

16. The Practice explained ciprofloxacin was chosen due to suspected acute pyelonephritis which may be complicated due to a suspected kidney stone and reported perineum (skin between the anus and scrotum) pain. It cannot recall if the MHRA warning associated with ciprofloxacin was communicated to Mr B. According to the Practice, ciprofloxacin is commonly prescribed because they effectively treat prostate infections.

17. In its response to Mr B’s complaint, the Practice mentioned its prescribing system did not alert it to the MHRA warning and it would be reviewing this with its supplier.

18. We reviewed Mr B’s record with our adviser. Our adviser directed us to NICE pyelonephritis guidance. This states:

‘Common signs and symptoms of pyelonephritis include:

• side/kidney angle pain and/or tenderness • muscle aches (myalgia) • flu-like symptoms • sudden cold or raised temperature of 37.9°C or higher • nausea/vomiting.’

19. Mr B’s presentation was not in keeping with acute pyelonephritis as there were no signs of a kidney infection. Our adviser explained possible diagnoses could have included abdominal cramp or a kidney stone. The presence of perineum pain would not have changed this.

20. We asked our adviser if the GP should have carried out any further tests to determine if a kidney stone or Mr B’s Crohn’s caused the pain. Our adviser explained it could have been considered as a differential diagnosis. As the appointment was an out of hours one, the Practice could not have arranged an onward investigation. As his pain had settled, our adviser told us standard practice would have been to refer Mr B to his GP or A&E if the pain returned. We can see the GP did advise this.

21. We have not seen any evidence Mr B presented with symptoms of acute pyelonephritis.

22. We asked our adviser if ciprofloxacin was an appropriate drug to treat acute pyelonephritis. Our adviser directed us to NICE guidance for pyelonephritis. The guidance states:

‘Other antibiotics should be chosen in the first instance with ciprofloxacin only used if other first-choice antibiotics are unsuitable. The guidance explains these circumstances as:

• there is resistance to other first-line antibiotics recommended for the infection • other first-line antibiotics are contraindicated in an individual patient • other first-line antibiotics have caused side effects in the patient requiring treatment to be stopped • treatment with other first-line antibiotics has failed.’

23. Our adviser explained ciprofloxacin is usually associated with rare but serious infections. Even if Mr B had acute pyelonephritis, this could have been treated with common antibiotics such as cephalexin or co-amoxiclav in the first instance.

24. We consider this to indicate a failing as the Practice should not have prescribed Mr B with ciprofloxacin.

Impact

25. Mr B says he experienced immediate stress and anxiety upon learning about ciprofloxacin’s side effects, leading to a three-week Crohn’s flare-up after 20 years of remission.

26. Ciprofloxacin is associated with a risk of serious, disabling, long-lasting and potentially irreversible adverse reactions. Reporting indicates this impacts between one and ten in every 10,000 patients.

27. Mr B says did not seek a diagnosis for his flare up, as he was familiar with his condition and managed the three-week episode independently without medical advice.

28. We asked our adviser if we could link Mr B’s learning about the side effects of ciprofloxacin with his flare up of Crohn’s.

29. Our adviser explained, while it would have been distressing for Mr B to learn about the side effects of ciprofloxacin, due to the number of potential factors which could have triggered a flare up of Mr B’s Crohn’s, we are unable to say the prescribing of ciprofloxacin caused it. We can also see Mr B stopped taking ciprofloxacin within three days.

30. As an outcome to his complaint, Mr B has told us he would like the Practice to:

• recognise prescribing ciprofloxacin was not appropriate • acknowledge the physical and psychological impact caused by the prescription • work with its prescribing system provider to ensure MHRA alerts are integrated into the system and • provide a financial remedy of £1,200.

31. We consider this failing to have been caused by a one-off incident of maladministration and would fall into level 1 of our severity of injustice scale. We would expect issues like this to be resolved by an apology and service improvements.

32. During this process, we contacted the Practice and asked if it would be willing to offer an apology to Mr B to put this complaint right. The Practice agreed to apologise to Mr B for inappropriately prescribing ciprofloxacin and acknowledging the impact this has had on him.

33. The Practice has also confirmed it will be reminding staff, when prescribing antibiotics, to refer to prescribing guidelines which will alert them to MHRA warnings. It will also be updating their induction material for new clinicians to place greater emphasis on this.

34. The Practice has confirmed it has reached out to the provider of the prescribing software. Work is currently on-going to improve real-time prescribing.

35. Our NHS Complaints Standards (2023) say organisations should find ‘suitable and appropriate ways to put things right for people who raise a complaint’.

36. We do not doubt this will have been distressing and annoying experience for Mr B. We would like to reassure Mr B our advisor has explained the risk of side effects, while understandably distressing, are low at between 1 and 10 people in every 10,000.

37. We are satisfied the Practice has taken steps to resolve this complaint. We would like to thank both parties for their time and effort during this process.

1. We have carefully considered Mr B’s complaint about a GP practice in Southeast England (the Practice). We were sorry to learn of the distress Mr B described to us. We appreciate this must have been a distressing experience for him.

2. We are pleased to note this matter has been resolved. This is because the Practice has agreed to issue an apology to Mr B and we are satisfied it has taken steps to prevent a similar situation happening again. As such we have decided not to take any further action.