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