Fluoroquinolones and Biofilm: A Narrative Review

Area of Science:

• Infectious Diseases
• Microbiology
• Pharmacology

Background:

• Biofilm-associated infections pose significant clinical challenges, often linked to medical devices and healthcare settings.
• Biofilms impede antimicrobial penetration, complicating treatment efficacy.
• Fluoroquinolones are vital for eradicating biofilm infections, with research exploring synergistic combinations.

Purpose of the Study:

• To critically assess the role of fluoroquinolones in managing biofilm-associated infections.
• To explore the benefits of combination therapy involving fluoroquinolones.
• To provide guidance on the optimal use of fluoroquinolones for biofilm infections.

Main Methods:

• Comprehensive literature search across PubMed/MEDLINE/Google Scholar and expert-authored books.
• Identification of studies focusing on fluoroquinolones and their activity against biofilms.
• Critical review and assessment of existing research findings.

Main Results:

• Fluoroquinolones demonstrate superior antibiofilm activity compared to beta-lactams and glycopeptides, but are less effective than minocycline and fosfomycin.
• Effective combinations include fluoroquinolones with fosfomycin/aminoglycosides (Gram-negative) and minocycline/rifampin (Gram-positive).
• In vitro studies dominate the literature, with limited in vivo evidence, though available real-world data align with fluoroquinolone effectiveness in early infections.

Conclusions:

• Fluoroquinolones remain fundamental in treating biofilm infections due to their bioavailability and synergistic potential.
• While effective, fluoroquinolones have limitations; combination therapies and newer agents are areas for future research.
• This review highlights fluoroquinolones' role and guides physicians on their best application against biofilm infections, acknowledging current challenges.