目的 分析近五年来喹诺酮类抗菌药物在临床应用中面临的耐药性、安全性及不合理用药问题，探讨解决策略。方法 系统检索2018-2023年间国内外研究、指南、监测报告及真实世界数据，重点纳入质粒介导耐药、严重不良反应、特殊人群用药及抗菌药物管理证据。结果 我国质粒介导的喹诺酮耐药（PMQR）基因检出率呈快速上升趋势，多重耐药菌对喹诺酮的耐药率普遍超过85%。氟喹诺酮类药物存在主动脉夹层、肌腱断裂等严重黑框警告风险，临床无指征使用、剂量疗程不规范问题突出。新型喹诺酮（如奈诺沙星）对部分耐药菌仍有效。结论 喹诺酮类抗菌药物的耐药形势严峻，安全性风险需高度警惕，不合理用药普遍。未来需加强抗菌药物管理、推广基于PK/PD的个体化用药，加速新药研发。

Objective To systematically analyze the key issues such as drug resistance, safety and irrational drug use faced by quinolone antibacterial drugs in clinical application in the past five years, and to explore the corresponding solutions. Methods systematically retrieved and sorted out domestic and international research, guidelines, monitoring reports and real-world data on quinolone antibacterial drugs from 2018 to 2023, with a focus on including evidence in areas such as plasmid-mediated resistance, serious adverse reactions, medication in special populations and antibacterial drug management. Results The detection rate of plasmid-mediated quinolone resistance (PMQR) genes has shown a rapid upward trend in China, and the quinolone resistance rate of multi-drug resistant bacteria generally exceeds 85%. Fluoroquinolone drugs carry serious black box warning risks such as aortic dissection and tendon rupture, and the problems of unindicated clinical use and non-standard dosage and treatment courses are prominent. New quinolones (such as nerofloxacin) remain effective against some drug-resistant bacteria. Conclusion The resistance situation of quinolone antibacterial drugs is severe, the safety risks need to be highly vigilant, and irrational drug use is widespread. In the future, it is necessary to strengthen the management of antibacterial drugs, promote individualized medication based on PK/PD, and accelerate the research and development of new drugs.Key words: Quinolone antibacterial drugs Plasmid-mediated drug resistance Drug safety; Medication for children Management of antibacterial drugs Therapeutic drug monitoring