Quinolones: their uses in geriatric infections

Area of Science:

• Pharmacology
• Infectious Diseases
• Geriatrics

Background:

• Quinolones are a distinct drug class offering new treatment options for infections.
• Older quinolones like nalidixic acid face significant resistance issues.
• Newer fluoroquinolones, such as norfloxacin and ciprofloxacin, present a potential solution.

Purpose of the Study:

• To evaluate the efficacy and safety of fluoroquinolones in treating infections in the elderly.
• To compare the resistance profiles of new fluoroquinolones with older agents.
• To identify specific infections where fluoroquinolones may be particularly beneficial.

Main Methods:

• Review of existing literature on quinolone and fluoroquinolone use in elderly patients.
• Analysis of antimicrobial activity spectrum, focusing on gram-negative bacilli and other pathogens.
• Assessment of pharmacokinetic properties, including oral absorption and potential for parenteral formulations.
• Evaluation of reported adverse effects and drug interactions.

Main Results:

• Fluoroquinolones exhibit bactericidal activity and good oral absorption.
• High activity against gram-negative bacilli, including Pseudomonas aeruginosa.
• Lower activity against certain bacteria like pneumococci, streptococci, Pseudomonas cepacia, and anaerobes.
• Potential utility in treating urinary tract infections, prostatitis, gastrointestinal infections, osteomyelitis, pneumonia, and STDs.
• Adverse effects in ~10% of patients, mainly gastrointestinal and potential CNS toxicity with concurrent medications.

Conclusions:

• Fluoroquinolones represent a valuable therapeutic option for diverse infections in the elderly.
• Their efficacy against resistant gram-negative pathogens and favorable resistance profile are significant advantages.
• Careful consideration of potential adverse effects and drug interactions is necessary.
• Oral fluoroquinolones may offer cost-effective treatment for serious infections in this population.