Preserving the efficacy of front-line fluoroquinolones through selective use to optimise clinical outcomes

Area of Science:

• Pharmacology and Infectious Diseases
• Antimicrobial Stewardship

Background:

• Increasing global antibiotic resistance necessitates judicious use of fluoroquinolones (FQs).
• Current FQs (ciprofloxacin, levofloxacin, moxifloxacin) demonstrate efficacy in various infections.
• Optimizing FQ selection is key to preserving class effectiveness.

Purpose of the Study:

• To evaluate the rationale for including ciprofloxacin and moxifloxacin alongside or over levofloxacin in formularies.
• To assess potential complementary clinical benefits and cost-effectiveness of specific FQs.
• To guide appropriate FQ selection for optimal patient outcomes and resistance mitigation.

Main Methods:

• Review of clinical studies on the efficacy and tolerability of approved fluoroquinolones.
• Comparative analysis of pharmacokinetic/pharmacodynamic profiles and in vitro activity.
• Assessment of specific advantages in treating Gram-negative and respiratory tract infections.

Main Results:

• Ciprofloxacin shows advantages in treating Gram-negative infections compared to levofloxacin.
• Moxifloxacin offers efficacy and ease-of-use benefits in respiratory tract infections over levofloxacin.
• Inclusion of ciprofloxacin and moxifloxacin may provide greater formulary value than levofloxacin alone.

Conclusions:

• Strategic inclusion of ciprofloxacin and moxifloxacin can enhance formulary utility and cost-effectiveness.
• Prioritizing FQs with superior in vitro activity and PK/PD profiles is essential for first-line use.
• Appropriate prescribing based on local guidelines minimizes resistance selection and preserves FQ efficacy.