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Future of the quinolones.

P Ball1

  • 1School of Biomedical Sciences, University of St. Andrews, St. Andrews, Fife, Scotland. Peterball1@aol.com

Seminars in Respiratory Infections
|September 20, 2001
PubMed
Summary

Newer fluoroquinolones, like moxifloxacin and gatifloxacin, show potent activity against resistant bacteria, including Streptococcus pneumoniae. These advanced antibiotics offer effective treatment for respiratory infections with favorable safety profiles.

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Area of Science:

  • Pharmacology
  • Microbiology
  • Infectious Diseases

Background:

  • Fluoroquinolones and fluoronaphthyridones are key in antibiotic development.
  • Previous agents like trovafloxacin, grepafloxacin, and clinafloxacin were withdrawn due to severe adverse drug reactions (hepatotoxicity, cardiotoxicity, phototoxicity).
  • QT interval prolongation is an emerging class effect with incompletely understood implications.

Purpose of the Study:

  • To review the safety and efficacy of existing and novel fluoroquinolone antibiotics.
  • To assess the role of fluoroquinolones in treating gram-negative infections and respiratory tract infections.
  • To evaluate the potential of new 8-methoxy quinolones against resistant bacterial strains, particularly Streptococcus pneumoniae.

Main Methods:

  • Review of clinical trial data, including Phase III development for new agents.
  • Analysis of postmarketing surveillance data (e.g., moxifloxacin in Germany).
  • Comparison of the activity spectrum and safety profiles of different fluoroquinolone generations.

Main Results:

  • Second-generation agents (ciprofloxacin, levofloxacin) have good safety profiles for gram-negative infections but raise concerns regarding Streptococcus pneumoniae resistance.
  • New 8-methoxy quinolones (moxifloxacin, gatifloxacin) demonstrate high potency against both susceptible and multidrug-resistant S. pneumoniae and retain activity against enterobacteria.
  • Phase III trials show satisfactory clinical and bacteriologic responses for respiratory infections with 8-methoxy quinolones, and postmarketing surveillance indicates a lack of significant adverse effects.

Conclusions:

  • Despite past safety concerns with some fluoroquinolones, agents like ciprofloxacin and levofloxacin remain important therapeutic options.
  • Newer 8-methoxy quinolones (moxifloxacin, gatifloxacin) represent a significant advancement, offering enhanced efficacy against resistant respiratory pathogens with a good safety profile.
  • Conservation strategies may be needed to preserve the utility of fluoroquinolones against emerging resistance, especially for Streptococcus pneumoniae.

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