Use of the new quinolones in cystic fibrosis

Monotherapy with pefloxacin, ofloxacin, or ciprofloxacin for acute exacerbations of bronchopulmonary infection in patients with cystic fibrosis has been shown to be as efficient as traditional intravenous therapy with beta-lactams and aminoglycosides, but these quinolones did not eliminate colonization with Pseudomonas aeruginosa. The only pharmacokinetic parameters that were consistently distinct in patients with cystic fibrosis vs. normal subjects were a higher maximal concentration of drug in serum and a smaller apparent volume of distribution in patients with cystic fibrosis, a finding that is likely related to a reduced cell mass in cachectic patients. Emergence of resistant strains of P. aeruginosa, with cross-resistance to other fluoroquinolones, has been a fairly common event during the course of therapy. Overall tolerance to the quinolones has been satisfactory. No toxic effect was observed in cartilage during or after therapeutic courses in young children. Consequently, it is urged that indications for the use of fluoroquinolones be broadened to include preadolescent patients.