Quinolones Flashcards
Name the 5 quinolone antibiotics available in the UK
- Ciprofloxacin
- Delafloxacin
- Levofloxacin
- Moxifloxacin
- Ofloxacin
What is the spectrum of activity of ciprofloxacin?
Active against both gram (+) and gram (-) bacteria HOWEVER more activity against gram (-)
Most anaerobes are not susceptible
What are the main gram (-) bacteria targeted by ciprofloxacin? (5)
- Salmonella
- Shigella
- Campylobacter
- Neisseria
- Pseudomonas
Ciprofloxacin has moderate activity against which gram (+) bacteria? (2)
- Strep pneumoniae
- Enterococcus faecalis
**should NOT be used to treat pneumococcal pneumonia; respiratory quinolones offer better protection
Can ciprofloxacin be used against chlamydia?
Yes
Can ciprofloxacin be used against mycobacteria?
SOME mycobacteria
What are the indications of ciprofloxacin? (5)
- Respiratory tract infections (but NOT pneumococcal pneumonia)
- GI infections (including typhoid fever)
- Bone and joint infections
- Gonorrhea
- Septicemia (caused by sensitive organisms)
What are the indications for ofloxacin? (4)
- UTIs
- Lower RTIs
- Gonorrhea
- Non-gonococcal urethritis and cervicitis
Which quinolones are considered “respiratory quinolones?” (2)
Levofloxacin and moxiflocacin due to their increased activity against Pneumococci (compared to ciprofloxacin)
Do quinolones have activity against staph?
Many staph species have developed resistance to quinolones; use of quinolones should be avoided in MRSA infections EXCEPT delafloxacin, which has activity against MRSA
Which quinolones are active against Pseudomonas?
Ciprofloxacin and Levofloxacin
What are the indications for delafloxacin?
- MRSA infection
2. Treatment of acute bacterial skin infections when standard treatment is inappropriate
Which quinolone has activity against MRSA?
Delafloxacin
What are the main adverse effects associated with the use of quinolones? (5)
- Convulsions (patients with or without a history of convulsions; taking NSAIDs at the same time may also induce them)
- Tendon damage (including rupture; may occur within 48 hours from starting treatment as well as several months after stopping treatment)
- Aortic aneurysm and dissection (particularly elderly patients)
- Heart valve regurgitation
- QT prolongation and torsades de pointes
What are the main contraindications of quinolones? (4)
- History of tendon disorders related to quinolone use
- Non-severe or self-limiting infection or non-bacterial conditions
- Pregnancy (except when using a single dose of ciprofloxacin to prevent meningococcal meningitis)
- History of quinolone hypersensitivity
When are quinolones indicated?
ONLY in severe and life-threatening infections where the benefits outweigh the risks of use OR in mild-moderate infections where alternatives are inappropriate
Unless other commonly recommended antibiotics are inappropriate, fluoroquinolones should not be prescribed for some mild to moderate infections, such as acute exacerbation of chronic bronchitis and chronic obstructive pulmonary disease, and ciprofloxacin or levofloxacin should not be prescribed for uncomplicated cystitis.
The use of quinolones with which drug is associated with increased risk of tendinitis and tendon rupture?
Corticosteroids
Increased risk also associated with patients >60 yo and in patients with renal impairment and solid-organ transplants
What risks must patients be informed of before starting treatment with quinolones?
Healthcare professionals are advised to inform patients to stop treatment at the first signs of a serious adverse reaction, such as tendinitis or tendon rupture, muscle pain, muscle weakness, joint pain, joint swelling, peripheral neuropathy, and CNS effects, and to contact their doctor immediately.
Quinolones should be prescribed with PARTICULAR caution in patients with which additional risk factors? ()
- Congenital pre-existing heart valve disease
- Connective tissue disorders eg Marfan, Ehlers-Danlos
- Other risk factors for conditions predisposing to heart valve regurgitation eg HTN, Turners, Behcet’s, RA, infective endocarditis
- Patients should be advised to seek immediate medical attention if they experience a rapid onset of shortness of breath (especially when lying down flat in bed), swelling of the ankles, feet, or abdomen, or new-onset heart palpitations.
What food and lifestyle measures should be advised when initiating ORAL quinolone therapy?
Avoid consuming oral quinolone antibiotics with dairy products or mineral-fortified drinks due to reduced absorption
