Quinolones Flashcards
MoA
Inhibits DNA synthesis
Broad spectrum (active against gram+ and gram-)
Bactericidal
Indications
LRTIs
UTIs
AVOID in MRSA infections (innate resistance)
Examples
Ciprofloxacin
Ofloxacin
Levofloxacin
Moxifloxacin
Delafloxacin
Ciprofloxacin
Gram + and -
PARTICULARLY against gram - (salmonella, shigella, campylobacteria, Neisseria, pseudomonas)
Moderate activity against gram +
Active against chlamydia and some mycobacteria
Ciprofloxacin - indications
RTIs (not pneumococcal pneumonia)
Infections of GI systems (including typhoid)
Bone + joint infections
Gonorrhoea
Septicaemia
Ofloxacin
UTI
LRTI
Gonorrhoea
Non-gonococcal urethritis and cervicitis
Levofloxacin
Gram + and -
Greater activity against Pneumococci than ciprofloxacin.
Moxifloxacin
Gram + and -
Greater activity against gram +, including Pneumococci than ciprofloxacin
QT prolongation
Life threatening hepatotoxicity
Delafloxacin
Gram + (including MRSA) and -
Acute bacterial skin and skin structure infections (ABSSSI) when standard treatments are inappropriate
Side effects - severe
Seizures
Tendon damage
QT prolongation
Arthropathy
Side effects - common
GI disturbances
Headache
Dizziness
QT prolongation
Ventricular arrhythmias
ESPECIALLY moxifloxacin (C/I in risk factors for QT prolongation)
Risk factors for QT prolongation
Electrolyte disturbances
Acute MI
HF with reduced LVEF
Bradycardia
Congenital long QT syndrome
Concomitant QT prolongation drugs
Symptomatic arrhythmias
Arthropathy
Avoid in pregnancy, children + adolescents
DISCONTINUE if…
Psychiatric, neurological and hypersensitivity reactions occur
Interactions - QT prolongation
SSRI
Quinine
Amiodarone
Macrolide
Antipsychotics
Increased risk of seizures
Ciprofloxacin + theophylline
Pk and Pd interaction
Ciprofloxacin is an enzyme inhibitor - causes theophylline toxicity
Theophilline SE = convulsions
NSAIDs
Induces convulsions
Counselling
Driving - can impair performance of skilled tasks; increased effect when taken with alcohol
Antacid and zinc/iron - 2 hours before or after taking
Milk - avoid milk with ciprofloxacin and norfloxacin
Protect skin from sunlight + avoid sunbeds
MHRA warnings
- Induces convulsions
- Tendon damage
- Small increased risk of aortic aneurysm and dissection
- Restrictions + precautions for use due to reports of disabling, potentially long-lasting and irreversible side effects
- Suicidal thoughts and behaviours
Induces convulsions
With or without a history of convulsions
Increased risk when taken with NSAIDs
Tendon damage
Occurs within 48 hours of starting up to months after stopping.
Stop if tenditis is suspected
- C/I in patietns with a history of tendon disorders related to quinolone use.
- Patients over 60 (more prone)
- Risk of tendon damage increased with corticosteroid use
Aneurysm
Small increased risk of aortic aneurysm + dissection
Factors that increase risk:
- FH of aneurysm disease
- Pre existing aortic aneurysm/aortic dissection
- Other risk factors predisposing to aortic aneurysm (e.g. hypertension + atherosclerosis)
Restrictions + precautions for use
Restrictions and precautions for use due to reports of disabling, potentially long-lasting and irreversible side effects.
Counsel patients to report:
- Tenditis
- Tendon rupture
- Muscle weakenss
- Joint pain
- Swelling
- Peripheral neuropathy
- CNS side effects
Small risk of heart valve regurgitation
Consider other therapeutic options first in those with:
- Congenital or pre-existing heart valve disease
- Connective tissue disorders
- Other risk factors predisposing to heart valve regurgitations (e.g. hypertension, RA, infective endocarditis)
Suicidal thoughts and behaviours
Can occur after the first dose
Seek advice if this occurs
