Why is cipro not a respiratory fluoroquinolone

J Antimicrob Chemother. Trovan trovafloxacin [Package insert]. New York, N. Gatifloxicin and moxifloxacin: two new fluoroquinolones. Med Lett Drugs Ther. Drug facts and comparisons: loose-leaf information service.

Sparfloxacin and levofloxacin. Stein GE, Ensberg M. Use of newer fluoroquinolones in the elderly. Clin Geriatr. Lietman PS. Fluoroquinolone toxicities.

An update. Zagam sparfloxacin [Product information]. Collegeville, Pa. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.

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Nalidixic acid NegGram. Gram-negative organisms but not Pseudomonas species. Uncomplicated urinary tract infections. Norfloxacin Noroxin. Lomefloxacin Maxaquin. Ciprofloxacin Cipro. Levofloxacin Levaquin. Acute exacerbations of chronic bronchitis, community-acquired pneumonia. Gatifloxacin Tequin. Moxifloxacin Avelox. Trovafloxacin Trovan. Same as for third-generation agents plus broad anaerobic coverage. Complicated urinary tract infections and pyelonephritis. Lower respiratory tract infections limited.

Skin and skin-structure infections. Urethral and cervical gonococcal infections. Urethral and cervical chlamydial and gonnococcal infections. Bone and joint infections, gram-negative bacterial infections. Acute exacerbations of chronic bronchitis. Community-acquired pneumonia. Intra-abdominal infections. Gynecologic and pelvic infections. Indeed, ciprofloxacin is not considered a respiratory fluoroquinolone and should not be substituted for either levofloxacin or moxifloxacin for community-acquired respiratory tract infections.

Differences among the respiratory fluoroquinolones should also be considered, such as potency against gram-positive and gram-negative pathogens and adverse events profile, including the potential for collateral damage.

Only when all of these factors are considered can a rational decision be made for the optimal positioning of the fluoroquinolones on each hospital formulary. References 1.

Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. A controlled trial of a critical pathway for treatment of community-acquired pneumonia. Marrie TJ. Experience with levofloxacin in a critical pathway for the treatment of community-acquired pneumonia. Feagan BG. Blondeau JM. A review of the comparative in-vitro activities of 12 antimicrobial agents, with a focus on five new respiratory quinolones.

J Antimicrob Chemother. Ciprofloxacin: an updated review of its pharmacology, therapeutic efficacy and tolerability. Bertino J Jr, Fish D. The safety profile of the fluoroquinolones. Clin Ther. Yip C, Lee AJ. Gatifloxacin-induced hyperglycemia: a case report and summary of the current literature. Levofloxacin: a review of its use in the treatment of bacterial infections in the United States.

Stable antimicrobial susceptibility rates for clinical isolates of Pseudomonas aeruginosa from the tracking resistance in the United States today surveillance studies. Int J Antimicrob Agents. Avelox moxifloxacin hydrochloride tablets; Avelox I. Bayer Pharmaceuticals Corp. June Available online at: www. Chapter 7:Selecting studies and collecting data.

Ho, P. Antibiotic resistance in community-acquired pneumonia caused by Streptococcus pneumoniae , methicillin-resistant Staphylococcus aureus , and Acinetobacter baumannii.

Chest , — Hooper, D. Emerging mechanisms of fluoroquinolone resistance. Huang, G. Sequential moxifloxacin therapy in the treatment of elderly patients with community-acquired pnuemonia: clinical evaluation Chinese.

Nanjing Med. Lee, J. High-dose levofloxacin in community-acquired pneumonia. Drug Invest. Leophonte, P. Li, B. A comparison between levofloxacin and cefuroxime with azithromycin in community-acquired pneumonia Chinese.

Lim, W. BTS guidelines for the management of community acquired pneumonia in adults: update Lin, T. Gung Med. PubMed Abstract Google Scholar. Liu, L. Efficacy of moxifloxacin vs. Drug Use Hosp. Lode, H. Mandell, L. Mikasa, K. Musher, D.

Community-acquired pneumonia. Portier, H. Moxifloxacin monotherapy compared to amoxicillin-clavulanate plus roxithromycin for nonsevere community-acquired pneumonia in adults with risk factors.

Postma, D. Antibiotic treatment strategies for community-acquired pneumonia in adults. Raja, A. Nat Rev Drug Discov. Shao, C. A randomized controlled multicentre clinical trial of levofloxacin sequential therapy compared with combination therapy with cefuroxime and azithromycin in patients with community-acquired pneumonia Chinese.

Suda, K. Antibiotic expenditures by medication, class, and healthcare setting in the united states, Clin Infect Dis. Tenson, T. The mechanism of action of macrolides, lincosamides and streptogramin B reveals the nascent peptide exit path in the ribosome. Thomas, C. Incidence and cost of pneumonia in medicare beneficiaries. Vardakas, K. Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials.

CMAJ , — Walsh, C. Where will new antibiotics come from? Welte, T. Treatment with sequential intravenous or oral moxifloxacin was associated with faster clinical improvement than was standard therapy for hospitalized patients with community-acquired pneumonia who received initial parenteral therapy. Clinical and economic burden of community-acquired pneumonia among adults in Europe. Woodhead, M. Guidelines for the management of adult lower respiratory tract infections—full version.

Guidance for clinical trials of anti- bacterial drugs Chinese. Xu, S. Efficacy and safety of intravenous moxifloxacin versus cefoperazone with azithromycin in the treatment of community acquired pneumonia. Huazhong Univ. Yang, S. Efficacy and cost-effectiveness analysis of moxifloxacin hydrochloride and combination of ceftriaxone sodium with azithromycin in the treatment of moderate to severe community acquired pneumonia in elderly patients Chinese.

Drugs 28, — Google Scholar. Fluoroquinolones, especially levofloxacin and ciprofloxacin, are valuable in the treatment of complicated urinary tract infections and pyelonephritis. Yet bacterial resistance, relapse of infections, and recurrent infections remain critical issues. Complex genitourinary tract infections continue to be a niche for this antibiotic class. Quinolones are effective in the treatment of prostatitis because of their excellent penetration into prostatic tissue.

When taken for four to six weeks, norfloxacin, ciprofloxacin, levofloxacin, and ofloxacin have eradication rates of 67 to 91 percent. Levofloxacin is an excellent first-line agent in the treatment of prostatitis. Ciprofloxacin should be reserved for use in patients with resistant gram-negative, pseudomonal, and enterococcal prostatitis, because of its superior activity against P.

Acute bacterial sinusitis may be the complication of an initial viral illness. The primary bacterial isolates are S.

Food and Drug Administration FDA has labeled gatifloxacin, moxifloxacin, sparfloxacin, and levofloxacin for use in the treatment of acute bacterial sinusitis. Clinical trials comparing fluoroquinolones with amoxicillin-clavulanate potassium Augmentin , cefuroxime axetil Ceftin , and clarithromycin Biaxin have demonstrated the efficacy of the quinolone antibiotics. Acute bronchitis may follow a viral illness, but antimicrobial therapy generally is not warranted unless the patient has underlying pulmonary disease.

Fluoroquinolone therapy for acute bacterial bronchitis has been effective against H. Community-acquired pneumonia is the sixth leading cause of death in the United States. Even with optimal therapy, this illness is associated with mortality rates of approximately 14 percent in hospitalized patients and less than 1 percent in patients not requiring hospitalization.

Listed antibiotic choices for outpatient treatment included macrolides, doxycycline Vibramycin , and fluoroquinolones. Antibiotic choices for hospitalized patients included fluoroquinolones or extended-spectrum penicillins piperacillin [Pipracil], piperacillintazobactam [Zosyn], or ampicillinsulbactam [Unasyn] , carbapenems meropenem [Merrem] and imipenemcilastatin [Primaxin] and cephalosporins, plus adjunctive macrolides, aminoglycosides, clindamycin Cleocin , or metronidazole Flagyl.

We are cautious when using quinolones and macrolides in elderly patients because of drug interactions and adverse effects. For the treatment of atypical pneumonias, macrolides are likely to be equivalent to fluoroquinolones and are currently more cost-effective. Quinolones provide exceptional coverage against atypical pathogens when infection with these organisms is suspected in patients with community-acquired pneumonia.

However, ofloxacin has been associated with treatment failures, and ciprofloxacin has displayed reduced activity against Chlamydia species. Compared with other quinolones, moxifloxacin and gatifloxacin have been shown to have superior in vitro activity against pneumococci. Although this activity may make moxifloxacin or gatifloxacin an attractive choice for pneumococcal infections, these agents should probably be reserved for treatment of infections with atypical pathogens or for life-threatening pneumonias.

Of the fluoroquinolones, ciprofloxacin and trovafloxacin have been studied most extensively in the treatment of nosocomial pneumonia. Ciprofloxacin has been found to be comparable in efficacy to imipenemcilastatin in mechanically ventilated patients, especially those infected with pathogens from the Enterobacteriaceae family, but it has also been associated with poorer responses and higher clinical failure rates in patients with nosocomial pneumonia caused by S.

At present, quinolones are best used in combination antimicrobial therapy for nosocomial pneumonia. Fluoroquinolone mono-therapy may worsen the increasing problem of antibiotic resistance in the nosocomial setting.

Based on guidelines from the CDC, 23 ceftriaxone is the agent of choice for treatment of uncomplicated Neisseria gonorrhoeae urethritis and cervicitis. A single dose of ciprofloxacin or ofloxacin should be considered as alternative treatment in, for example, patients with penicillin allergy.

Finally, ciprofloxacin has been reported to be as effective as trimethoprim-sulfamethoxazole for treating chancroid caused by Haemophilus ducreyi. Pelvic inflammatory disease is a polymicrobial infection. Quinolone treatment options include ofloxacin plus metronidazole, ofloxacin plus cefoxitin Mefoxin , and ciprofloxacin plus clindamycin.

Prophylactic antimicrobial therapy is not recommended for the prevention of diarrhea in travelers. Ciprofloxacin and ofloxacin are the agents of choice for treatment of enteric typhoid fever. Because of limited data, the role of fluoroquinolones in the treatment of skin and soft tissue infections remains uncertain. Most fluoroquinolones have limited gram-positive activity; thus, they should not be considered first-line agents for skin and soft tissue infections.

Diabetic foot infections, which are polymicrobial, can be treated with quinolones in combination with other antibiotics. Although quinolones are well tolerated and relatively safe, certain adverse effects are common with all agents in this antibiotic class Table 2. CNS: headache, dizziness, drowsiness, confusion, insomnia, fatigue, malaise, depression, somnolence, seizures, vertigo, lightheadedness, restlessness, tremor.

Other: QTc prolongation, hepatotoxicity, abnormal or bitter taste, tendon rupture. Information from references 5 , 6 , 11 , and 24 through Prolongation of the corrected QT interval QTc may precipitate fatal ventricular arrhythmias such as torsades de pointes. Secondary to its effects in prolonging the QTc, grepafloxacin Raxar was withdrawn from the U. Because of reported QTc prolongation, sparfloxacin and moxifloxacin should not be used in patients with a known predisposition to arrhythmias e.

Clinically significant drug interactions are known to occur with all quinolones Table 3. Fluoroquinolones have a be reduced by 25 percent to approximately role in postexposure prophylaxis and 90 percent. Decreased absorption of quinolones if didanosine Videx or multivalent cations are administered concomitantly or less than two hours before or after a quinolone.

May prolong QTc if used concomitantly with antiarrhythmics e. May increase risk of CNS stimulation and convulsions if used concomitantly with nonsteroidal anti-inflammatory drugs. Decreased absorption if used concomitantly with sodium citrate and citric acid oral solution Bicitra. Decreased effect of orally administered trovafloxacin if used concomitantly with intravenously administered morphine.

Newer fluoroquinolones, such as gatifloxacin Tequin , moxifloxacin Avelox , and trovafloxacin Trovan , may not interact significantly with calcium-containing products. Avoid concomitant use of fluoroquinolones and sucralfate Carafate. Information from references 6 , 7 , 11 , and 24 through Bacillus anthracis anthrax spores have recently been deployed as a biologic weapon in the United States.

Fluoroquinolones have a role in postexposure prophylaxis and chemotherapy for specific agents that could be used in biologic warfare Table 4. Ciprofloxacin is the drug of choice for postexposure prophylaxis for anthrax until sensitivities are available.

Although penicillin resistance has only rarely occurred in the natural setting of anthrax, the former Soviet Union developed a B. Agents of choice: ciprofloxacin, doxycycline Alternative if organisms are penicillin sensitive: penicillin G.

Agents of choice: oral rehydration therapy, tetracycline, doxycycline, ciprofloxacin, norfloxacin Noroxin. Agents of choice: doxycycline, ciprofloxacin Alternative: tetracycline. Agents of choice: streptomycin, gentamicin, ciprofloxacin Alternative: doxycycline.