Fluoroquinolones

Ciprofloxacin and ofloxacin are available for intravenous use. Their broad spectrum of activity, oral or intravenous administration, and safety have encouraged inappropriate use, and resistance is increasing, particularly in Ps. aeruginosa and MRSA. They inhibit bacterial DNA gyrase and are bactericidal. They are active against staphylococci and streptococci, but should not be used in preference to penicillins. Neisseria species, Hemophilus species, and a high proportion of the Enterobacteriaceae are susceptible. Pseudomonas species are moderately susceptible, but high doses are needed to inhibit pseudomonads in the lungs. Excretion is by the kidney. The quinolones are used to treat complicated urinary infections and prostatitis. Other agents should be used for community-acquired pneumonia. They are first-line agents in severe Salmonella and Shigella infections. Osteomyelitis and soft tissue infections caused by Gram-negative bacteria and gonorrhea are other indications. Gastrointestinal symptoms, rash, and rarely convulsions occur. Quinolones are not recommended in children, unless there is no alternative, because of their potential effect on growing cartilage.

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