The fluoroquinolone class of antibiotics promises to become as diverse and as important
as β-lactam agents. The fluoroquinolones inhibit bacterial DNA gyrase and are bactericidal.
All fluoroquinolones have potent activity against most gram-negative bacteria; ciprofloxacin
is the most active against Pseudomonas aeruginosa. Activity against gram-positive organisms is variable; methicillin-resistant Staphylococcus aureus has acquired resistance to the fluoroquinolones at an alarming rate. Currently available
quinolones do not have, but new quinolone agents likely will have, substantial activity
against anaerobic bacteria. Some quinolones are also active against Mycobacterium, Chlamydia, and Mycoplasma organisms. All fluoroquinolones have excellent absorption after oral administration;
however, this process can be impaired by the presence of aluminum- or magnesium-containing
antacids and by zinc, iron, or calcium supplements. Ciprofloxacin is also available
for intravenous use. Although most fluoroquinolones do not achieve adequate cerebrospinal
fluid levels, penetration into other tissues is excellent. Dosage adjustments for
renal and hepatic dysfunction vary among the quinolones. Although side effects are
rare, concomitant use of caffeine or theophylline with some quinolones may cause toxicity
to the central nervous system. Because they may affect the development of cartilage,
all fluoroquinolones are contraindicated in children, adolescents, and pregnant or
breast-feeding women.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Mayo Clinic ProceedingsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Efficacy, safety, and potential economic benefits of oral ciprofloxacin in the treatment of infections.Rev Infect Dis. 1988; 10: 528-543
- Increasing resistance of Staphylococcus aureus to ciprofloxacin.Antimicrob Agents Chemother. 1990; 34: 1862-1863
- Emerging resistance to fluoroquinolones in staphylococci: an alert (editorial).Ann Intern Med. 1991; 114: 424-426
- Rapid development of ciprofloxacin resistance in methicillin-susceptible and -resistant Staphylococcus aureus.J Infect Dis. 1991; 163: 1279-1285
- Fluoroquinolone antimicrobial agents.Clin Microbiol Rev. 1989; 2: 378-424
- Fluoroquinolone antimicrobial agents.N Engl J Med. 1991; 324: 384-394
- The quinolones.Infect Dis Clin North Am. September 1989; 3: 625-639
- Structure-activity relationships of the fluoroquinolones.Antimicrob Agents Chemother. 1989; 33: 131-135
- Mode of action of the quinolone antimicrobial agents: review of recent information.Rev Infect Dis. 1989; 11: S902-S911
- Quinolone uptake by bacteria and bacterial killing.Rev Infect Dis. 1989; 11: S941-S946
- Chemical evolution of the fluoroquinolone antimicrobial agents.Am J Med. 1989; 87: 2S-9S
- Bacterial resistance to quinolones: mechanisms and clinical importance.Rev Infect Dis. 1989; 11: S960-S968
- Clinical study of strains of Pseudomonas aeruginosa and Serratia marcescens resistant to new quinolones in complicated urinary tract infection.Rev Infect Dis. 1989; 11: S969-S970
- Activities of ciprofloxacin and ofloxacin against rapidly growing mycobacteria with demonstration of acquired resistance following single-drug therapy.Antimicrob Agents Chemother. 1990; 34: 65-70
- Plasmid-mediated 4-quinolone resistance: a real or apparent absence?.Antimicrob Agents Chemother. 1990; 34: 681-684
- Laboratory survey of fluoroquinolone activity.Rev Infect Dis. 1989; 11: S917-S924
- Ciprofloxacin therapy for methicillin-resistant Staphylococcus aureus infections or colonizations.Antimicrob Agents Chemother. 1989; 33: 181-184
- Use of quinolones in chlamydial infections.Rev Infect Dis. 1989; 11: S1273-S1276
- Antimicrobial activity of ciprofloxacin against Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus determined by the killing curve method: antibiotic comparisons and synergistic interactions.Antimicrob Agents Chemother. 1985; 28: 331-342
- Synergy of fluoroquinolones with other antimicrobial agents.Rev Infect Dis. 1989; 11: S1025-S1035
- Emergence of ciprofloxacin resistance and nosocomial methicillin-resistant Staphylococcus aureus isolates: resistance during ciprofloxacin plus rifampin therapy for methicillin-resistant S. aureus colonization.Arch Intern Med. 1990; 150: 2151-2155
- Pharmacokinetics of the quinolones in volunteers: a proposed dosing schedule.Rev Infect Dis. 1988; 10: S83-S89
- New quinolones: pharmacology, pharmacokinetics, and dosing in patients with renal insufficiency.Rev Infect Dis. 1988; 10: S102-S105
- Concentrations of ofloxacin in serum and cerebrospinal fluid of patients without meningitis receiving the drug intravenously and orally.Antimicrob Agents Chemother. 1989; 33: 1686-1690
- Tissue penetration of the new quinolones in humans.Rev Infect Dis. 1989; 11: S1046-S1057
- Use of fluoroquinolones for intracellular pathogens.Rev Infect Dis. 1989; 11: S979-S984
- Metabolism of gyrase inhibitors.Rev Infect Dis. 1989; 11: S1119-S1129
- Drug interactions with quinolones.Rev Infect Dis. 1989; 11: S1083-S 1090
- Inhibition of norfloxacin absorption by antacids.Antimicrob Agents Chemother. 1990; 34: 432-435
- Effect of ferrous sulfate and multivitamins with zinc on absorption of ciprofloxacin in normal volunteers.Antimicrob Agents Chemother. 1989; 33: 1841-1844
- Sucralfate significantly reduces ciprofloxacin concentrations in serum.Antimicrob Agents Chemother. 1990; 34: 931-933
- Theophylline dosage adjustment during enoxacin coad-ministration.Antimicrob Agents Chemother. 1990; 34: 803-807
- Effects of enoxacin on renal and metabolic clearance of theophylline in rats.Antimicrob Agents Chemother. 1990; 34: 1739-1743
- Safety of fleroxacin coadministered with theophylline to young and elderly volunteers.Antimicrob Agents Chemother. 1990; 34: 1249-1253
- Treatment of genitourinary tract infections with fluoroquinolones: activity in vitro, pharmacokinetics, and clinical efficacy in urinary tract infections and prostatitis.Antimicrob Agents Chemother. 1989; 33: 1655-1661
- Comparative studies of fluoroquinolones in the treatment of urinary tract infections.Rev Infect Dis. 1988; 10: S153-S163
- Use of quinolones in urinary tract infections and prostatitis.Rev Infect Dis. 1989; 11: S1321-S1337
- Low-dose norfloxacin vs. placebo for long-term prophylaxis of recurrent uncomplicated urinary tract infection (abstract).Rev Infect Dis. 1989; 11: S1363-S1364
- Coordinated multicenter study of norfloxacin versus trimethoprim-sulfamethoxazole treatment of symptomatic urinary tract infections.J Infect Dis. 1987; 155: 170-177
- Randomized, double-blind comparison of ciprofloxacin and trimethoprim-sulfamethoxazole for complicated urinary tract infections.Antimicrob Agents Chemother. 1988; 32: 1327-1330
- Multicenter randomized study of single-dose ofloxacin versus amoxicillin-probenecid for treatment of uncomplicated gonococcal infection.Antimicrob Agents Chemother. 1989; 33: 167-170
- Comparison of ofloxacin and ceftriaxone in the treatment of uncomplicated gonorrhea caused by penicillinase-producing and non-penicillinase-producing strains.Antimicrob Agents Chemother. 1990; 34: 148-149
- Treatment of genitourinary tract infections with fluoroquinolones: clinical efficacy in genital infections and adverse effects.Antimicrob Agents Chemother. 1989; 33: 1662-1667
- Failure of norfloxacin to eradicate Chlamydia trachomatis in nongonococcal urethritis.Antimicrob Agents Chemother. 1986; 30: 594-597
- Dose-ranging study of fleroxacin for treatment of uncomplicated Chlamydia trachomatis genital infections.Antimicrob Agents Chemother. 1989; 33: 1774-1777
- Ciprofloxacin compared with doxycycline for nongonococcal urethritis: ineffectiveness against Chlamydia trachomatis due to relapsing infection.JAMA. 1990; 264: 1418-1421
- Evaluation of fleroxacin (RO 23-6240) as single-oral-dose therapy of culture-proven chancroid in Nairobi, Kenya.Antimicrob Agents Chemother. 1989; 33: 612-614
- Use of norfloxacin to treat chronic typhoid carriers.J Infect Dis. 1988; 157: 1221-1225
- Comparison of single-dose treatment with norfloxacin and standard 5-day treatment with trimethoprim-sulfamethoxazole for acute shigellosis in adults.Antimicrob Agents Chemother. 1989; 33: 1101-1104
- Ciprofloxacin for Salmonella bacteremia in the acquired immunodeficiency syndrome (AIDS).Ann Intern Med. 1989; 110: 1027-1029
- Ciprofloxacin or trimethoprim-sulfamethoxazole as initial therapy for travelers' diarrhea: a placebo-controlled, randomized trial.Ann Intern Med. 1987; 106: 216-220
- Lack of emergence of resistant fecal flora during successful prophylaxis of travelers' diarrhea with norfloxacin.Antimicrob Agents Chemother. 1986; 30: 671-674
- Quinolones in the treatment of Salmonella carriers.Rev Infect Dis. 1989; 11: S1179-S1187
- Failure of ciprofloxacin to eradicate convalescent fecal excretion after acute salmonellosis: experience during an outbreak in health care workers.Ann Intern Med. 1991; 114: 195-199
- Impact of fluoroquinolones on the gastrointestinal flora.Rev Infect Dis. 1989; 11: S1372-S1378
- Prevention of infections in granulocytopenic patients by fluorinated quinolones.Rev Infect Dis. 1989; 11: S1231-S1236
- Infection prophylaxis in acute leukemia: a comparison of ciprofloxacin with trimethoprim-sulfamethoxazole and colistin.Ann Intern Med. 1987; 106: 7-12
- Ofloxacin versus co-trimoxazole for prevention of infection in neutropenic patients following cytotoxic chemotherapy.Antimicrob Agents Chemother. 1990; 34: 215-218
- Randomized trial comparing ciprofloxacin plus netilmicin versus piperacillin plus netilmicin for empiric treatment of fever in neutropenic patients.Antimicrob Agents Chemother. 1989; 33: 87-91
- Use of quinolones for the treatment of patients with bacteremia.Rev Infect Dis. 1989; 11: S1156-S1159
- Intravenous ciprofloxacin for nosocomial lower respiratory tract infections (abstract).Rev Infect Dis. 1989; 11: S1225-S1226
- Use of the new quinolones in cystic fibrosis.Rev Infect Dis. 1989; 11: S1245-S1252
- Quinolones in the treatment of lower respiratory tract infections.Rev Infect Dis. 1989; 11: S1212-S1219
- Diffusion kinetics of pefloxacin in human bone following a single infusion (abstract).Rev Infect Dis. 1989; 11: S1265-S1266
- Use of quinolones for the treatment of osteomyelitis and septic arthritis.Rev Infect Dis. 1989; 11: S1259-S1263
- Oral ciprofloxacin compared with parenteral antibiotics in the treatment of osteomyelitis.Antimicrob Agents Chemother. 1990; 34: 40-43
- Treatment of bone, joint, and soft-tissue infections with oral ciprofloxacin.Antimicrob Agents Chemother. 1987; 31: 151-155
- Ofloxacin versus parenteral therapy for chronic osteomyelitis.Antimicrob Agents Chemother. 1991; 35: 538-541
- Treatment of disseminated Mycobacterium avium complex infection in AIDS with amikacin, ethambutol, rifampin, and ciprofloxacin.Ann Intern Med. 1990; 113: 358-361
- Successful treatment of malignant external otitis with oral ciprofloxacin: report of experience with 23 patients.J Infect Dis. 1990; 161: 537-540
- Quinolone therapy for infections of the central nervous system.Rev Infect Dis. 1989; 11: S1194-S1202
- Pefloxacin treatment of meningitis caused by gram-negative bacteria.Arch Intern Med. 1989; 149: 1314-1316
- Evaluation of single-dose ciprofloxacin in the eradication of Neisseria meningitidis from nasopharyngeal carriers.Antimicrob Agents Chemother. 1988; 32: 1740-1741
- Single-dose ciprofloxacin in the management of outbreaks of meningococcal disease (abstract).Rev Infect Dis. 1989; 11: S1209-S1210
- Widespread quinolone resistance among methicillin-resistant Staphylococcus aureus isolates in a general hospital.Antimicrob Agents Chemother. 1989; 33: 593-594
- Emergence of ciprofloxacin-resistant coagulase-negative staphylococcal skin flora in immunocompromised patients receiving ciprofloxacin.J Infect Dis. 1990; 161: 41-44
- Ciprofloxacin and rifampin, alone and in combination, for therapy of experimental Staphylococcus aureus endocarditis.Antimicrob Agents Chemother. 1989; 33: 1184-1187
- Long-term use of quinolones and their safety.Rev Infect Dis. 1989; 11: S1365-S1370
- Adverse reactions in a dose-ranging study with a new long-acting fluoroquinolone, fleroxacin.Antimicrob Agents Chemother. 1989; 33: 1778-1782
- Specific toxicologic aspects of the quinolones.Rev Infect Dis. 1988; 10: S141-S146
- Adverse effects of the fluoroquinolones.Rev Infect Dis. 1988; 10: S258-S261
- Acute renal failure secondary to oral ciprofloxacin therapy: a presentation of three cases and a review of the literature.Clin Nephrol. 1989; 32: 75-78
- Serum sickness-like illness associated with ciprofloxacin.Antimicrob Agents Chemother. 1990; 34: 904-905
- Anaphylactoid reactions reported after treatment with ciprofloxacin.Ann Intern Med. 1989; 111: 1041-1043
- In vitro and in vivo activities of a new quinolone, WIN 57273, possessing potent activity against gram-positive bacteria.Antimicrob Agents Chemother. 1990; 34: 568-575
- WIN 57273, a new fluoroquinolone with enhanced in vitro activity versus gram-positive pathogens.Antimicrob Agents Chemother. 1990; 34: 1376-1380
- Comparative in vitro activities of a new quinolone, WIN 57273, and piperacillin plus tazobactam against anaerobic bacteria.Antimicrob Agents Chemother. 1990; 34: 1858-1861
- Antistaphylococcal activities of sparfloxacin (CI-978; AT-4140), ofloxacin, and ciprofloxacin.Antimicrob Agents Chemother. 1990; 34: 1843-1845
- Inappropriate use of oral ciprofloxacin.JAMA. 1990; 264: 1438-1440
Article info
Footnotes
Individual reprints of this article are not available. The entire Symposium on Antimicrobial Agents will be available for purchase as a bound booklet from the Proceedings Circulation Office at a later date.
Identification
Copyright
© 1991 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.