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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

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Fluoroquinolones for Dermatologists: A Practical Guide to Clinical Use and Risk Management.

Samer Wahood¹, Omar Alani², Iyla Draw³

¹The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.

Pharmaceuticals (Basel, Switzerland)

|June 27, 2025

Summary

Fluoroquinolones are valuable for skin infections but carry risks like tendinopathy and QT prolongation. Selective use, considering patient factors and resistance, is key for effective and safe treatment.

Keywords:

antibiotic stewardship bacteria dermatology fluoroquinolone risk management safety skin skin and soft tissue infections tendinopathy toxicity

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Area of Science:

Dermatology
Infectious Diseases
Pharmacology

Background:

Fluoroquinolones are used for bacterial skin and soft tissue infections, including those caused by Pseudomonas aeruginosa and multidrug-resistant organisms.
Effective due to tissue penetration and bactericidal activity, their use is tempered by safety concerns like tendinopathy, QT prolongation, phototoxicity, and antimicrobial resistance.

Purpose of the Study:

To provide practical guidance on the clinical application of topical and oral fluoroquinolones in dermatological practice.
To review the efficacy, safety profile, and antimicrobial resistance patterns associated with fluoroquinolone use in skin infections.

Main Methods:

Comprehensive literature search of PubMed, Scopus, and Web of Science (1985-2025) using terms like 'quinolone,' 'fluoroquinolone,' 'dermatology,' and 'skin infection.'
Inclusion of government regulatory agency information via Google search.
Exclusion of abstracts and presentations to focus on peer-reviewed articles.

Main Results:

Delafloxacin showed over 90% cure rates for complicated skin infections.
Significant safety concerns persist, including a ninefold increased risk of tendinopathy with corticosteroid co-administration and QT prolongation risks.
Phototoxicity varies by agent, and resistance to ciprofloxacin is notable in certain bacterial populations (e.g., E. coli, P. aeruginosa).

Conclusions:

Fluoroquinolones remain essential in dermatology when judiciously prescribed.
Optimal use necessitates careful consideration of patient risk factors, evolving resistance trends, and robust antimicrobial stewardship.