Quinolones 11. Pasteurella 1. M.

Tuberculosis
multocida 2. M. Kankasii
Quinolones 12. Aeromonas 3. M. fortuitum
- Are chemically related compounds of Nalidixic hydrophila
acid which was the first class of antimicrobial 13. Salmonella
agents use for the treatment of UTI. 14. Shigella
15. Campylobacter
Nalidixic acid jejuni
 Suboptimal pharmacokinetic profile 16. Yersinia
 Narrow spectrum enterocolitica
 Microbial resistance problem 17. Vibrio
18. P. acroginosa
Floroquinolones 19. H. influenza
- Differ from older compounds in that they a
fluorine at the position C6, and a piperazinyl 20. H. ducreyi Activity against anaerobic baderia is
moiety at C7 position of the quinolone 21. Neisseria poor
nucleus. meningitis
22. N. gonorrhoea
23. Branhamella
catathalic

Poor activity against Anerobic bacteria (except

Tosufloxacin)
Members:

1. Ciprofloxacin 8. Enoxacin
Sesquihydrate
2. Norfloxacin 9. Rosoxacin
3. Pefloxacin 10. Fleroxacin
4. Ofloxacin 11.
Tosufloxacin
Mechanism of Action
5. Levofloxacin 12.
Sparfloxacin
They interfere with bacterial DNA synthesis by
6. Moxifloxacin 13.
inhibiting topoisomerase II (DNA gyrase) and
Grepafloxacin
topoisomerase IV.
7. Lumifloxacin
Antimicrobial Activity - Bactericidal
Pharmacokinetics
Antimicrobial Spectrum - broad
- Bioavailability after oral adm – 95-100%
Gm (-) bacteria Gm (+) Orgs - Elimination is through renal excretion via active
tubular secretion. Pefloxacin is metabolize by
1. E. coli 1. Methicillin susceptible and
the liver (non- renal excretion). Moxifloxacin,
2. Klebsiella resistant strain of
sparfloxacin, and trovafloxacin are eliminated
3. Enterobacter a. S. Auerus
partly by hepatic and biliary excretion.
4. Serratia b. S. Epidermidis
marcescens c. Other coagulase (-) staph
Drug Interaction:
5. Proteus
6. Morganella
1. Al(OH)3 + Mg(OH)3 (Antacid) GI absorption
7. Providenica 2. Streptococcus pneumonia 2. Sucralfate
8. Citrobacter (same as M3) 3. Inhibits theophylline met. serum level of
9. Acidetobacter 3. Strep A, B, C, D and G – theophyllin
10. Eikenella are only marginally
corrodens susceptible
Other Organism
(Drug) Adverse Effects – Infrequent M. Tuberculosis, M. avium - Ciprofloxacin
1. GIT dist
2. CNS dist (headache, restlessness, dizziness
tremors, rarely seizure)
3. Skin reaction, photosensitization When fluroquinolones are Not indicated:
4. serum transaminases, LOH, alk PO4
5. Cartilage erosion in children 1. Uncomplicated UTI that can be treated with
cheaper or alteration agents
2. Bacteriuria or UTI assoc with foreign bodies
Summary of appropriate indication for (e.g. foley catheter, renal calculi) in which
fluoroquinolones: prolonged therapy will just select out resistant
bacteria.
3. P.I.D due to syphilis
Indications Preferred 4. S. aureus osteomylitis
fluoroquinolones 5. Community acquired pneumonia due to S.
1. Complicated UTI in which - All fluoroquinolone will pneumonia, mycoplasma
orgs resistant to usual oral work 6. Aspiration pneumonia (due to anaerobic
antibiotics exist organisms)
7. Strep grp A or S. aureus skin infections
2. Chronic bacterial - 1st choice – Ofloxacin, 8. Otitis media / sinusitis
prostatis when THR-SMZ but any will work 9. Anaerobic infections
cannot be use or has failed 10. Children, pregnant women and nursing mothers.
3. Osteomylitis due to - Ciprofloxacin Specific Clinical Uses of some fluroquinolones
susceptible gm (-) bacilli
but not due to S. aureus Levofloxacin
4. Invasive (malignant) - Ciprofloxacin – good activity against organisms assoc with community
external otitis due to P. –
aeroginosa acquired pneumonia. Including atypical pneumonia.

5. Gm (-) nosocomial - Ciprofloxacin Sparfloxacin

pneumonia
6. Shigella infections
7. traveler’s diarrhea
8. Several bacterial gm (-)
infections bacteria
gastroenteritis/salmonella
Gm (-) soft tissue
infections
9. Uncomplicated Gonorrhea -
- Single dose
10. Chlamydia trachomatis
11. Chancroid due to H.
ducreyi
12. Mycobacterium
infections:
activity against gm (+) organisms including penicillin –
resistant pneumococci.
- Any will work
Contraindicated in patients taking drugs that prolong the
a. Norfloxacin QT interval. (e.g. antiarrhythmic agents)
b. Ciprofloxacin
Moxifloxacin & trovafloxacin
- Ciprofloxacin is the 1st – have the widest spectrum including gm (-) and
choice anaerobic bacteria
Grepfloxacin
– can cause serious cardiotoxicity
Any will work
a. Ciprofloxacin 500mg
b. Ofloxacin 400mg
c. Norfloxacin 800mg
d. Enoxacin 400mg
- Ofloxacin 300mg P.O
bid for 7 days
- Ciprofloxacin
500mg x 3 days
- (resistant cases only)
- Ciprofloxacin ofloxacin