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RavLect16: Quin
Fluoroquinolones
Question | Answer |
---|---|
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 |