Indications

Gram-Negative Rods

• Escherichia Coli (see Escherichia Coli)
• Klebsiella (see Klebsiella)
• Proteus (see Proteus)
• Providencia (see Providencia)
• Pseudomonas Aeruginosa (see Pseudomonas Aeruginosa)
• Serratia (see Serratia)

Gram-Positives

• Enterococcus (see Enterococcus, [[Enterococcus]]): not recommended
• Staphyloccus Aureus (see Staphyloccus Aureus, [[Staphyloccus Aureus]])
  • Methicillin-Sensitive Staphylococcus Aureus (MSSA): not recommended (as only levofloxacin/moxifloxacin/gemifloxacin are active)
  • Methicillin-Resistant Staphylococcus Aureus (MRSA): not recommended (as there are high levels of resistance to ciprofloxacin and newer fluoroquinolones)
• Staphylococcus Epidermidis (see Staphylococcus Epidermidis, [[Staphylococcus Epidermidis]])
  • Methicillin-Sensitive Staphylococcus Epidermidis (MSSE): not recommended (as only levofloxacin/moxifloxacin/gemifloxacin are active)
  • Methicillin-Resistant Staphylococcus Epidermidis (MRSE): not recommended (as there are high levels of resistance to ciprofloxacin and newer fluoroquinolones)
• Streptoccocus Pneumoniae (see Streptoccocus Pneumoniae, [[Streptoccocus Pneumoniae]]): newer fluoroquinolones have increased activity against Streptococcus Pneumoniae and other Gram-positive organisms, as compared to ciprofloxacin

Anerobes

• Bacteroides (see Bacteroides, [[Bacteroides]]): not recommended (as moxifloxacin is the only current fluoroquinolone with clinically-significant anaerobic coverage)

Respiratory Pathogens

• Chlamydophila Pneumoniae (see Chlamydophila Pneumoniae, [[Chlamydophila Pneumoniae]]): not recommended
• Haemophilus Influezae (see Haemophilus Influezae, [[Haemophilus Influezae]]): not recommended
• Legionella Pneumophila (see Legionellosis, [[Legionellosis]]): not recommended
• Moraxella Catarrhalis (see Moraxella Catarrhalis, [[Moraxella Catarrhalis]]): not recommended
• Mycoplasma Pneumoniae (see Mycoplasma Pneumoniae, [[Mycoplasma Pneumoniae]]): not recommended
• Streptoccocus Pneumoniae (see Streptoccocus Pneumoniae, [[Streptoccocus Pneumoniae]]): newer fluoroquinolones have increased activity against Streptococcus Pneumoniae and other Gram-positive organisms, as compared to ciprofloxacin

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Pharmacology

• Fluoroquinolone Antibiotic (see Fluoroquinolones, [[Fluoroquinolones]])

Metabolism

• xxx

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Administration

• PO:
• IV:

Dose Adustment

• Hepatic:
• Renal

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Adverse Effects

Cardiovascular Adverse Effects

Q-T Prolongation with Definite Association with Torsade (see Torsade, [[Torsade]])

• Epidemiology: fluoroquinolones have a definite association with torsade
  • However, the risk of Q-T prolongation with fluoroquinolones is mainly related to additive effects with other Q-T prolonging drugs, as the risk when used alone is small
• Physiology: dose-dependently block cardiac voltage-gated potassium channels -> delay in cardiac repolarization
  • Class Effect
• Risk of Q-T Prolongation
  • High Risk
    • Gatifloxacin (Tequin) (see Gatifloxacin, [[Gatifloxacin]])
    • Grepafloxacin (Raxar) (see Grepafloxacin, [[Grepafloxacin]])
    • Moxifloxacin (Avelox, Avalox, Avelon) (see Moxifloxacin, [[Moxifloxacin]])
    • Sparfloxacin (Spacin, Zagam) (see Sparfloxacin, [[Sparfloxacin]])
  • Medium Risk
    • Gemifloxacin (see Gemifloxacin, [[Gemifloxacin]])
    • Levofloxacin (Levaquin) (see Levofloxacin, [[Levofloxacin]])
    • Ofloxacin (Floxin, Ocuflox) (see Ofloxacin, [[Ofloxacin]])
    • Sitafloxacin (Gracevit) (see Sitafloxacin, [[Sitafloxacin]])
    • Tosufloxacin (Ozex) (see Tosufloxacin, [[Tosufloxacin]])
  • Low Risk
    • Ciprofloxacin (Cipro)
  • Canadian Drug Safety and Effectiveness Research Network (CDSERN) Study of Sudden Death in Patients Co-Prescribed Sulfamethoxazole/Trimethoprim + Either ACE-I or ARB’s(2014) [MEDLINE]
    • Study: n = 39,879 sudden deaths -> 1027 occurred within 7 days of exposure to an antibiotic
    • Main Findings: ciprofloxacin was also associated with an increased risk of sudden death (adjusted odds ratio 1.29, 1.03 to 1.62)

Hematologic Adverse Effects

• Acquired Von Willebrand Disease (see Von Willebrand Disease, [[Von Willebrand Disease]]):
• Possible Risk of Hemolysis in Patient with G6PD Deficiency (see Glucose-6-Phosphate Dehydrogenase Deficiency, [[Glucose-6-Phosphate Dehydrogenase Deficiency]] and Hemolytic Anemia, [[Hemolytic Anemia]])

Orthopedic Adverse Effects

• Tendinitis/Tendon Rupture (see Tendon Rupture, [[Tendon Rupture]])

Other Adverse Effects

• xxxx

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References

• Co-trimoxazole and sudden death in patients receiving inhibitors of renin-angiotensin system: population based study. BMJ. 2014;349:g6196