Clinical Uses

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Therapeutic uses of the quinolones include urinary and respiratory tract infections, GI and abdominal infections, STDs, and bone, joint, and soft tissue infections. Nalidixic acid is effective for urinary tract infections; however, bacteria can become resistant, particularly if the drug is used for long periods. The second-generation fluoroquinolones are all equally efficacious in UTIs, and their activity is comparable to that of TMP-SMX. These drugs have shown efficacy in treating prostatitis and can serve as an alternative therapy for patients not responding to TMP-SMX.

The fluoroquinolones have a variety of indications in the treatment of respiratory infections, although they may not be the drugs of choice; these infections include acute and chronic bacterial sinusitis. A second-generation cephalosporin, such as cefuroxime, is usually the drug of choice in acute sinusitis associated with M. catarrhalis, H. influenzae, and S. pneumoniae. The second-generation quinolones usually have poor activity in treating community-acquired pneumonia (CAP) because of their poor activity against S. pneumoniae. The third- and fourth-generation fluoroquinolones are significantly more effective in treating CAP because of their activity against S. pneumoniae. The fluoro-quinolones are also indicated for nosocomial pneumonia, chronic bronchitis (acute exacerbations), and chronic otitis media.

The fluoroquinolones have indications for a variety of GI infections, including traveler's diarrhea due to E. coli, shigellosis, and typhoid fever. In the AIDS patient these drugs are effective in treating bacteremias and eradicating the carrier state due to nontyphoidal organisms. Importantly, the fluoroquinolones are contraindi-cated in the treatment of enterohemorrhagic E. coli because they can induce the cytotoxic Shiga-like toxin.

Primary cervicitis, urethritis, and extended infections, such as pelvic inflammatory disease due to the STD agents N. gonorrhoeae and C. trachomatis, are successfully treated with fluoroquinolones. Both cipro-floxacin and ofloxacin appear to be more effective than other fluoroquinolones, although resistance has been reported to be emerging. Because coinfections in patients treated with ciprofloxacin and ofloxacin are frequent, especially in women (>50%), caution should be observed in using these agents if resistance becomes predominant in either infecting organism. Ciprofloxacin and ofloxacin are ineffective against Treponema pal-lidum but are active against the less common Haemo-philus ducreyi.

The use of fluoroquinolones in bone and joint infections is influenced by the causative agent and the rate of resistance development. The use of the oral route for administration of the fluoroquinolones is especially ad vantageous in treating chronic infections that often require long-term therapy.

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