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Updated: Jun 6, 2026
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Optimal use of fluoroquinolones in the intensive care unit setting
John C Rotschafer1, Mary A Ullman, Christopher J Sullivan
1Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, WDH 7-189, 308 Harvard Street SE, Minneapolis, MN 55455, USA. rotsc001@umn.edu
Abstract:
Fluoroquinolones have become a staple antimicrobial in a variety of settings for a wide spectrum of infectious diseases. Although fluoroquinolones have been associated with a broad spectrum of adverse events, the side effect profile is generally acceptable. Their use in the intensive care unit as empiric therapy is becoming compromised due to the development of multiple drug resistant gram negative pathogens and collateral damage with C difficile & MRSA. Fluoroquinolones should be used along with another antibiotic of different chemical structure, mechanism of action, and pharmacodynamic profile to ensure adequate initial antimicrobial coverage and maximize the likelihood of a favorable clinical and microbiologic response.
Insights
Fluoroquinolones are vital antimicrobials but their effectiveness is declining due to resistant bacteria. Combining them with other antibiotics improves treatment outcomes for serious infections.
Area of Science:
- Pharmacology and Infectious Diseases
- Antimicrobial Resistance
Background:
- Fluoroquinolones are widely used for various infections.
- Despite known adverse events, their safety profile is generally acceptable.
- Emerging antimicrobial resistance and collateral effects like C. difficile and MRSA impact their efficacy.
Purpose of the Study:
- To evaluate the current role and limitations of fluoroquinolones in treating infectious diseases.
- To highlight the challenges posed by antimicrobial resistance in intensive care settings.
- To provide recommendations for optimizing fluoroquinolone use.
Main Methods:
- Review of current literature on fluoroquinolone use and resistance patterns.
- Analysis of clinical data regarding fluoroquinolone efficacy and adverse events.
- Pharmacodynamic and pharmacokinetic considerations for combination therapy.
Main Results:
- Fluoroquinolone effectiveness is compromised by multidrug-resistant Gram-negative pathogens.
- Collateral damage includes increased risk of Clostridioides difficile and Methicillin-resistant Staphylococcus aureus (MRSA).
- Current empiric use in intensive care units faces significant challenges.
Conclusions:
- Fluoroquinolones should be used judiciously due to rising resistance.
- Combination therapy with agents of different mechanisms is recommended.
- Optimizing antimicrobial coverage enhances clinical and microbiological response.
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