Broad spectrum antibiotics with good penetration in the skin and soft tissues.
Exhibit concentration dependent activity eradicating organisms when they achieve concentrations at least 10 times higher than the minimum inhibitory concentration (MIC).
New agents have improved oral bioavailability, longer half life and possible fewer sided affects than older agents.
Third generation agents have increased activity against Streptococcus pneumonia and Staphylococcus aureus and still retain activity against gram negative bacteria.
FDA supports treatment of infections with pneumonia, acute bacterial sinusitis, exacerbation of chronic bronchitis, skin infections, cronic bacterial prostatitis, UTI’s, acute pyelonephritis, and inhalational anthrax.
FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions
FDA-approved fluoroquinolones include levofloxacin (Levaquin), ciprofloxacin (Cipro), ciprofloxacin extended-release tablets, moxifloxacin (Avelox), ofloxacin, gemifloxacin (Factive) and delafloxacin (Baxdela), with more than 60 generic versions.
Mental health side effects are disturbances in attention, disorientation, agitation, nervousness, memory impairment and delirium.
There are instances of hypoglycemic coma where users of fluoroquinolones experienced hypoglycemia..
Risk of worsening symptoms for those with myasthenia gravis.
Potential for irreversible peripheral neuropathy.
Because the risk of serious side effects generally outweighs the benefits for patients with acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis and uncomplicated urinary tract infections, the FDA determined that fluoroquinolones should be reserved for use in patients with these conditions who have no alternative treatment options.
Newer agents have less activity against Pseudomonas aeruginosa.
Enhance expression of matrix metalloproteinases in tissue, which can lead to tendon injury, most commonly in the elderly.
Fluoroquinolones may be associated with severe Clostridium difficile colitis.
Active use may be associated with retinal detachment.
Quinolone antibiotics may bind to metallic cations such as bismuth, and should not be taken concurrently with bismuth subsalicylate.
Evidence suggests that exposure is consistently associated with the small significantly increased risk of aortic dissection in aortic aneurysm (Singh S).
Use of fluoroquinolones strongly associated with retinal detachment with a 4.5 fold increased risk for ongoing drug exposure ( Etminan M et al).
In a Danish study the use of oral fluoroquinolones was not associated with increased risk of retinal detachment (Pasternak B et al).
Presently pref2242ed prophylactic antobiotics for chemotherpay induced neutropenia because of potent activity against gram negative bacteria, enhanced gram positive coverage, excellent oral bioavailability and is well tolerated.
Associated with Achilles’ tendon rupture, and tendinopathy at multiple muscle sites.
The relative risk of Achilles tendinitis in fluoroquinolone users is about 3.7%.
A safety review performed by the FDA showed that when fluoroquinolones were used systemically, they were associated with disabling and potentially permanent serious adverse effects that can occur together and can involve the tendons, muscles, joints, nerves, and central nervous system.
May be associated with anxiety,depression, insomnia, panic attacks, impaired thinking, depersonalization, suicidal thoughts, psychosis, nightmares, and impaired memory, neuro psychiatric toxicities and mitochondrial toxicity.
Four fold increased risk of Achilles tendinopathy and a two fold increased risk of tendon rupture.
Suggested induction of tendon degeneration with up regulation of proteolytic enzymes, decreased collagen production, inhibition of cell proliferation, and apoptosis.
Link to cardiac disturbances in the general population.
May be associated with serious adverse effects including QT prolongation, and hypoglycemia.
May be associated with the development of peripheral neuropathy and patients should be monitored for the development of impaired neurologic function of arms and legs.
Patients may develop pain, burning, tingling, numbness, weakness or touch sensitivity changes in light touch, pain or temperature of the extremities.
Neuropathic symptoms may develop soon after initiation of fluoroquinolone therapy, and at anytime during treatment.
Neuropathic symptoms may last for months, years or even be permanent.
Associated with fluctuations in blood glucose, including hypoglycemia and hypoglycemia.
Increased risk of hypoglycemia in diabetics.
Associated with collagen degradation raising concerns about serious collegen disorders with use of these antibiotics including aortic aneurysm and dissection.
Mental health side effects are disturbances in attention, disorientation, agitation, nervousness, memory impairment, and delirium.
Have a potential risk for coma with hypoglycemia.
Associated with worsening symptoms in those with myasthenia gravis, and for irreversible peripheral neuropathy.
The FDA suggests that these serious side effects generally outweigh the benefits for patients with acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis and uncomplicated urinary tract infections, and fluoroquinolones should be reserved for use in patients with these conditions who have no alternative treatment options.