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Fluoroquinolones
1Medical College of Pennsylvania, Philadelphia, USA.
Abstract:
Since the introduction of the floroquinolones for clinical use in the late 1980s, they have been used successfully for a large number of clinical situations. As experience accumulates, the indications and optimal use of these agents gradually become more clear. Unfortunately, two of the pathogens for which these agents were most promising--methicillin-resistant S. aureus and P. aeruginosa--have developed resistance. Currently, the quinolones are excellent agents for the treatment of complicated urinary tract infections, including those caused by P. aeruginosa. In addition, they should be considered as initial therapy for the treatment of severe bacterial gastroenteritis. The quinolones should also be considered when attempting to eradicate the chronic stool carriage of S. typhi. These agents also offer significant advantages in the treatment of osteomyelitis and prostatitis caused by gram-negative bacilli that frequently require prolonged antimicrobial therapy. Treatment of STDs, especially gonorrhea, is another clear indication for their use. Ciprofloxacin should be considered as initial therapy in patients with malignant otitis externa and in cystic fibrosis patients with exacerbations secondary to P. aeruginosa in the sputum. The role of the quinolones for soft tissue and respiratory tract infections is less clear and their use probably should be limited to certain situations in which there is a clear advantage over beta-lactams, macrolides, and trimethoprim-sulfamethoxazole. The new quinolones, fleroxacin, perfloxacin, sparfloxacin, and tosufloxacin, which are being developed and tested for clinical use, will offer advantages in once-a-day dosing and better gram-positive antimicrobial activity. Because the inappropriate or heavy use of the fluoroquinoles has resulted in considerable development of resistance, it is imperative that they be used only when there is a distinct advantage over conventional therapy in terms of efficacy, safety, or cost. Otherwise, the rapid development of resistance will jeopardize the potentially bright future for this entire class of compounds.
Insights
Fluoroquinolones are effective for many infections, including complicated urinary tract infections and bacterial gastroenteritis. However, resistance in pathogens like MRSA and P. aeruginosa necessitates judicious use to preserve their future efficacy.
Area of Science:
- Pharmacology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Fluoroquinolones introduced in the late 1980s have broad clinical applications.
- Increasing bacterial resistance, particularly from methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa, poses a significant challenge.
- Optimal use and evolving indications for fluoroquinolones require continuous evaluation.
Purpose of the Study:
- To review the current clinical applications and efficacy of fluoroquinolones.
- To highlight specific infections where fluoroquinolones offer distinct advantages.
- To emphasize the critical need for responsible antimicrobial stewardship to mitigate resistance.
Main Methods:
- Literature review of clinical studies and antimicrobial resistance patterns.
- Analysis of fluoroquinolone efficacy in various infectious disease contexts.
- Evaluation of emerging fluoroquinolone agents and their potential benefits.
Main Results:
- Fluoroquinolones remain valuable for complicated urinary tract infections (UTIs), severe bacterial gastroenteritis, and eradicating S. typhi carriage.
- They are advantageous in treating osteomyelitis, prostatitis, and STDs, including gonorrhea.
- Emerging fluoroquinolones promise improved dosing and gram-positive activity, but resistance necessitates careful prescribing.
Conclusions:
- Judicious use of fluoroquinolones is imperative, prioritizing situations with clear advantages over other antimicrobials.
- Antimicrobial stewardship is crucial to combat resistance and preserve the therapeutic value of fluoroquinolones.
- Responsible prescribing ensures the long-term viability of this important class of antibiotics.