Fluoroquinolones

Fluoroquinolones are agents related to nalidixic acid and include ciprofloxacin , norfloxacin , ofloxacin , moxifloxacin ,
levofloxacin , and gemifloxacin . They are bactericidal for growing bacteria.

Fluoroquinolones inhibit DNA gyrase

Spectrum Activity
a. Cipro and Levo have activity against P. aeruginosa, but the fluoroquinolones as a group have variable activity
against non–P. aeruginosa. Ciprofloxacin is active against some anaerobes; it has moderate activity against M.
tuberculosis.
b. Gram-positive organisms are less susceptible than gram-negative organisms but usually are sensitive, except for
Enterococcus faecalis and methicillin-resistant staphylococci.
c. Ofloxacin has the greatest activity against Chlamydia.
Uses
a. Norfloxacin is indicated for the oral treatment of urinary tract infections, uncomplicated gonococcal infections, and
prostatitis.
b. Ciprofloxacin, ofloxacin, and levofloxacin are available orally and intravenously. Ciprofloxacin is approved for use
in urinary tract infections; lower respiratory infections; sinusitis; bone, joint, and skin structure infections; empiric use
in febrile neutropenic patients; typhoid fever; urethral and cervical gonococcal infections; and infectious diarrhea.
c. Ofloxacin is approved for use in lower respiratory infections, uncomplicated gonococcal and chlamydial cervicitis
and urethritis, skin and skin structure infections, prostatitis, and urinary tract infections.
d. Levofloxacin is approved for the treatment of urinary tract infections.
e. Moxifloxacin is approved for the treatment of complicated intra-abdominal infections but should not be used for
urinary tract infections
f.Ciprofloxacin: drug of choice for prophylaxis/treatment of Anthrax
g.Ciprofloxacin, levofloxacin used in chlamydial urethritis/cervicitis
h. Levofloxacin, Gatifloxacin, Gemifloxacin & Moxifloxacin, so-called respiratory FQs are used for treatment of upper
and lower RTIs
Side Effect and precaution
Occasional adverse effects include nausea, dyspepsia, headache, dizziness, insomnia, cardiac QT prolongation,
arthropathy, tendonitis, CNS effects, photosensitivity, and hypoglycemia.
b. Infrequent adverse effects include rash, urticaria, leukopenia, and elevated liver enzymes. Crystalluria occurs with
high doses at alkaline pH.
c. The FDA has added a black box warning about the increased risk of developing tendinitis and tendon rupture in
patients taking this class of medications.
d. FQs may damage growing cartilage and cause Arthropathy hence, these are not suitable for patients under 18 years
of age
e. Should be avoided in pregnancy
Interactions
a. Ciprofl oxacin has been shown to increase theophylline levels. Variable effects on theophylline levels have been
reported from other members of the group. In patients requiring fluoroquinolones, theophylline levels should be
monitored.
b. Antacids and sucralfate and divalent or trivalent cations such as iron significantly decrease the absorption of
fluoroquinolones.
c. Fluoroquinolones may increase prothrombin times in patients receiving warfarin.
d. Concurrent use with nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk of CNS stimulation
(seizures).
e. Fluoroquinolones may produce prolonged QT interval when administered with antiarrhythmic agents. Some
fluoroquinolones (i.e., gemifloxacin, moxifloxacin) should be avoided in patients with known prolongation of the QTC
interval, with uncorrected hypocalcemia, or who are receiving class IA or class III antiarrhythmic drugs.
f. Some fluoroquinolones have been reported to enhance the effects of oral anticoagulants.
g. Hyperglycemia and hypoglycemia have been reported in patients receiving quinolones and an antidiabetic agent.
Blood glucose monitoring is recommended in such patient