Fluoroquinolone Drugs
STEP 2: Indications of Fluoroquinolone Drugs:
Fluoroquinolones include;
Nalidixic acid, norfloxacin, ciprofloxacin, oxfloxacin and levofloxacin.
The remarkably powerful and specific activity of antimicrobial drugs is due to their selectivity for targets that are either unique to microorganisms or much more important in them than in humans.
Fluoroquinolones are active against a variety of gram-positive and gram-negative bacteria
Nalidixic acid and norfloxacin are effective in uncomplicated urinary-tract infections.
Ciprofloxacin is active against both Gram-positive and Gram-negative bacteria. It is particularly active against Gram-negative bacteria, including salmonella, shigella,campylobacter, neisseria, and pseudomonas.
Ciprofloxacin has only moderate activity against Gram-positivebacteria such as Streptococcus pneumoniae and Enterococcusfaecalis; it should not be used for pneumococcal pneumonia.It is active against chlamydia and some Mycobacteria Ofloxacin is used for urinary-tract infections, lowerrespiratory-tract infections, gonorrhoea, and non-gonococcalurethritis and cervicitis
.Levofloxacin is active against Gram-positive and Gramnegativeorganisms. It has greater activity against pneumococci than ciprofloxacin. Levofloxacin is licensed for community-acquired pneumonia but it is considered to be second-line treatment for this indication
STEP 3: Contraindication of Fluoroquinolones Drugs:
Fluoroquinolones are contraindicated in:
Pregnancy.
Patients with a history of tendon disorders related to quinolone use.
Severe hepatic impairment
Bradycardia.
History of symptomatic arrhythmias
Heart failure.
Electrolyte disturbances.
STEP 4: Dose, Dosage and Course of Fluoroquinolone drugs:
Ciprofloxacilin By mouth, respiratory-tract infections, 500 to 750 mg twice daily (750 mg twice daily in pseudomonal lower respiratory-tract infection in cystic fibrosis)
Urinary-tract infections, 250750 mg twice daily (250 mg twice daily for 3 days usually adequate for acute uncomplicated cystitis in women).
Acute or chronic prostatitis, 500 mg twice daily for 28 days Gonorrhoea, 500 mg as a single dose.
Most other infections, 500 mg twice daily (increased to 750 mg twice daily in severe or deep-seated infection).
Surgical prophylaxis [unlicensed], 750 mg 60 minute before procedure
Prophylaxis of meningococcal meningitis by intravenous infusion over 60 minutes, 400 mg Anthrax (treatment and post-exposure prophylaxis, every 8 to 12 hours by mouth, 500 mg twice daily By intravenous infusion over 60 minutes, 400 mg every 12 hours.
Levofloxacilin By mouth, acute sinusitis, 500 mg daily for 1014 days.
Exacerbation of chronic bronchitis, 250 to 500 mg daily for 7 to 10 days.
Community-acquired pneumonia, 500 mg once or twice daily for 7 to 14 days.
Urinary-tract infections, 250 mg daily for 7 to 10 days(for 3 days in uncomplicated infection).
Chronic prostatitis, 500 mg once daily for 28 days.
Skin and soft tissue infections, 250 mg daily.
STEP 4: Side Effects and Adverse Effects of Fluoroquinolone Drugs:
Adverse effects and side effects of Fluoroquinolones.
Fluoroquinolones are extremely well tolerated.
The most common effects are nausea, vomiting, and diarrhea .
Occasionally, headache, dizziness, insomnia, skin rash, or abnormal liver function tests develop.
Photosensitivity has been reported with lomefloxacin and pefloxacin may damage growing cartilage and cause an arthropathy ,Tendinitis, a rare complication that has been reported in adults.
STEP 5: Interactions and Precautions of Essential Fluoroquinolone Drugs:
Interaction of Fluoroquinolones :
Also should avoided in those receiving quinidin procainamide sotalol, ibutilide, amiodarone).
Patients receiving other agent like erythromycin, tricyclic ,antidepressants should be given fluoroquinolones with caution.
Precaution:
Quinolones should be used with caution in:
Patients with a history of epilepsy or conditions that
Renal impairment
Pregnancy
During breast-feeding
Quinolones may induce convulsions in patients with or without a history of convulsions
Should be used with caution in condition that predispose to seizures and myasthenia gravis .
Taking NSAIDS at the same time may also induce them
Step 7: Key Points:
Some commonly used Fluoroquinolones are:
Nalidixic acid and norfloxacin, ciprofloxacin, oxfloxacin and levofloxacin.
Fluoroquinolones are contra-indicated in patients with a history of tendon disorders related to Fluoroquinolones use, patient with hepatic impairment and in pregnancy.
Nausea, vomiting and diarrhea are common side effects .
Fluoroquinolones can be given orally or by injection.
Fluoroquinolones can predispose to seizure and mythaenia gravis.
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