[Fluoroquinolones in respiratory infections]

Given orally, currently marketed fluoroquinolones, ciprofloxacin, ofloxacin and pefloxacin are absorbed rapidly, have an excellent diffusion coefficient. They are wide-spectrum first intention antibiotics effective against Gram negative bacilli, staphylococci and intracellular germs such as Legionella, Chlamydiae and mycoplasms. The spectrum does however not include streptococci, and in particular pneumococci, and anaerobic germs. The development of resistant strains, particularly in hospital settings, have been observed and despite their fundamental properties, the use of fluoroquinolones has been restrained for infections of the respiratory tract. Actually, the insensitivity of pneumococci or anaerobic germs means that fluoroquinolones cannot be used empirically for isolated cases of pneumonia or sinusitis. They can however be used successfully, either empirically, in a combination regimen or after identification of the bacteria, for treating infections due to Gram negative bacilli (superinfection of chronic bronchitis or cystic fibrosis, otitis) or intracellular germs (pneumonia). In the near future, when new fluoroquinolones active against pneumococci or anaerobic germs are introduced, therapeutic options will be modified.