Agents
- Ciprofloxacin (Cipro) (see Ciprofloxacin, [[Ciprofloxacin]])
- Gatifloxacin (Tequin) (see Gatifloxacin, [[Gatifloxacin]])
- Gemifloxacin (Factive) (see Gemifloxacin, [[Gemifloxacin]])
- Grepafloxacin (Raxar) (see Grepafloxacin, [[Grepafloxacin]]): withdrawn from worldwide markets in 1999
- Levofloxacin (Levaquin) (see Levofloxacin, [[Levofloxacin]])
- Moxifloxacin (Avelox, Avalox, Avelon) (see Moxifloxacin, [[Moxifloxacin]])
- Ofloxacin (Floxin, Ocuflox) (see Ofloxacin, [[Ofloxacin]])
- Sitafloxacin (Gracevit) (see Sitafloxacin, [[Sitafloxacin]])
- Sparfloxacin (Spacin, Zagam) (see Sparfloxacin, [[Sparfloxacin]]): withdrawn from US market
- Tosufloxacin (Ozex) (see Tosufloxacin, [[Tosufloxacin]])
- Trovafloxacin (Trovan, Turvel) (see Trovafloxacin, [[Trovafloxacin]]): withdrawn from US market
Pharmacology
- Fluoroquinolone Antibiotics
Gram-Negative Coverage
- Fluoroquinolones Have Adequate Activity Against Enteric Gram-Negative Rods
- General Spectrum of Gram-Negative Rod Activity: levofloxacin had same overall spectrum of activity again Gram-negative rods as ofloxacin, but is 2x more potent
- Pseudomonas Aeruginosa: levofloxacin has less activity against than ciprofloxacin
- Pseudomonas Aeruginosa/Serratia/Providencia/Proteus: moxifloxacin has less activity against these organisms than ciprofloxacin
Gram-Positive Coverage
- Newer Fluoroquinolones Have Increased Activity Against Streptococcus Pneumoniae and Other Gram-Positive Organisms, as Compared to Ciprofloxacin
- Methicillin-Sensitive Staphylococcus Aureus (MSSA): levofloxacin/moxifloxacin/gemifloxacin are active
- Methicillin-Sensitive Staphylococcus Epidermidis (MSSE): levofloxacin/moxifloxacin/gemifloxacin are active
- Methicillin-Resistant Staphylococcus Aureus (MRSA): have high levels of resistance to ciprofloxacin and newer fluoroquinolones
- Methicillin-Resistant Staphylococcus Epidermidis (MRSE): have high levels of resistance to ciprofloxacin and newer fluoroquinolones
- Enterococcus: levofloxacin/moxifloxacin activities are marginal
Anerobic Coverage
- Moxifloxacin is the Only Currently Available Agent Which Has Clinically-Significant Anaerobic Coverage
- Bacteroides Species: anaerobic activity of moxifloxacin has been shown to be comparable to that of piperacillin-tazobactam (Zosyn) and amoxicillin-clavulanic acid (Augmentin)
- However, resistance rates may be as high as 25-30% in some centers
Respiratory Pathogen Coverage
- Streptococcus Pneumoniae: newer fluoroquinolones have increased activity against Streptococcus Pneumoniae and other Gram-positive organisms, as compared to ciprofloxacin
- Gemifloxacin Has Unusually High Activity Against Streptococcus Pneumoniae, as Compared to Other Fluoroquinolones
- Haemophilus Influezae/Moraxella Catarrhalis/Legionella Pneumophila/Mycoplasma Pneumoniae/Chlamydophila Pneumoniae: all newer fluoroquinolones have good activity against these pathogens
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
- Risk of Q-T Prolongation
- High Risk
- 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
Pulmonary Adverse Effects
Drug-Induced Pulmonary Eosinophilia (see Drug-Induced Pulmonary Eosinophilia, [[Drug-Induced Pulmonary Eosinophilia]])
Other Adverse Effects
References
- Torsade de pointes probably induced by sparfloxacin. J Assoc Physicians India. 2002 Aug;50:1077-8 [MEDLINE]
- Levofloxacin-Induced Torsades de Pointes. Tex Heart Inst J. 2010;37(2):216-7 [MEDLINE]