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RavLect16: Quin


Fluoroquinolones •Ciprofloxacin – Cipro •Levofloxacin – Levaquin •Moxifloxacin – Avelox •Gemifloxacin – Factive These are the first line drugs against Atypicals (weird bugs)!
Quinolone MoA Selectively inhibit type II topoisomerases Topoisomerase IV target for G+ DNA gyrase target for G-
Mech of resistance to Quinolones Chromosomal (gyr A/B or Par C/E mutations) Permeability alterations Efflux
Quinolone PK Concentration dependent Rapidly Cidal Widely distrib. into most body tissues including lungs (pneumonia), prostate, and CSF Has Post-antiBx effect, but not clinically used b/c toxic in high doses
Clinical use of Cipro UTIs: Cipro & Levo. Cipro used when SPACE suspected Systemic infect: Cipro (except for Pneumococcus & enterococcus). Intra-abdominal infect: Cipro+Flagyl Cipro (& maybe Levo) are the only ORAL drugs for pseudomonas
Clinical Use of Levo, Moxi, and Gemi Levo, Moxi, Gemi: MSSA, sometimes MRSA. Cover S. pneumo (unlike Cipro) and E. faecalis, but not faecium. Listeria Moxi has increased anaerobe coverage. Good for some IA infections. Gemi & Moxi for CAP, AECB (acute exacer of chron bronchitis), DRS
Quinolone best activity: Enterobacteriaceae, H. ducreyii, H. influenza, M. catarrhalis moxi, gemi & increased Strep, N. gonorrhoeae resistance has increased and coverage is not as excellent as in the past, ‘atypicals’ Chlamydia, Mycoplasma, Legionella
Quinolone activity against Pseudomonas Ciprofloxacin > gemifloxacin=moxifloxacin> levofloxacin UTI only, cipro & levo are adequate alone Pyelonephritis: Cipro
Quinolone activity against S. pneumoniae (Pneumococcus) Gemifloxacin > moxifloxacin> levofloxacin (No Cipro!)
Quinolone activity against S. aureus Moxifloxacin> levofloxacin
Quinolone activity against Anaerobes (eg. B. fragilis) Moxifloxacin is the best against anaerobes such as B. frag.
Alternative Quinolone uses Alternative Uses: •Traveler’s diarrhea •Osteomyelitis •Otitis media •Bioterrorism related anthrax post exposure prophylaxis •Empiric therapy for severe CAP in a high risk patient or those requiring hospitalization
Quinolone counseling tips finish all medication minimize UV exposure, sunlight water/hydration bioavailability issues (Don't take with Ensure, calcium, antacids, etc.) arthropathy (joint pain) & tendon rupture risk hypo/hyperglycemia teratogenicity
Ciprofloxacin IV dose 750mg Q12h
Quinolone ADRs Tendonitis & arthropathy hyper/hypglycemia when used with antidiabetic agents QT prolongation Cipro: vasculitis Teratogenicity Many DDIs: Multivalent cations, sucralfate, cimetidine, didanosine, caffeine, theophylline, warfarine, foscarnet,
Primary Use of Quinolones •Multi drug resistant Streptococcus pneumoniae (5% decade ago 35-45% today) •Complicated UTI with P. aeruginosa in which Cipro PO would be preferred over IV therapy •Prostate infections
Created by: cheeoh