Fluoroquinolone complications

Uncomplicated urinary tract infections can be managed most effectively with short-course (3 days) therapy with either trimethoprim-sulfamethoxazole or a fluoroquinolone. Complicated infections require longer treatment periods (2 weeks) usually with one of these agents. 

Complicated exacerbation FEV, less than 50% predicted Comorbid cardiac disease Greater than or equal to 3 exacerbations per year Antibiotic therapy in the previous 3 months Above organisms plus drug-resistant pneumococci, P-lactamase-producing H. influenzae and M. catarrhalis, Escherichia coli, Proteus spp., Enterobacter spp., Klebsiella pneumoniae Oral P-Lactam/P-Iactamase inhibitor (amoxicil 1 i n-clavulanate) Fluoroquinolone with enhanced pneumococcal activity (levofloxacin, gemifloxacin, moxifloxacin) Intravenous P-Iactam/P-Iactamase inhibitor (ampicillin-sulbactam) Second- or third-generation cephalosporin (cefuroxime, ceftriaxone) Fluoroquinolone with enhanced pneumococcal activity (levofloxacin, moxifloxacin)... 

Clinicians should be aware that dosage regimens with the same drug maybe different depending on the infectious process. For example, ciprofloxacin, a fluoroquinolone, has various dosage regimens based on site of infection. The dosing for uncomplicated UTIs is 250 mg twice daily for 3 days. For complicated UTIs, the dose is 500 mg twice daily for 7 to... 

Patients with complicated typhoid fever (i.e., metastatic foci, ileal perforation, etc.) should receive parenteral therapy with ciprofloxacin 400 mg twice daily or ceftriaxone 2000 mg once daily. Antimicrobial therapy can be completed with an oral agent after initial control of the symptoms of typhoid fever. In persons with AIDS and a first episode of Salmonella bacteremia, a longer duration of antibiotic therapy (1-2 weeks of parenteral therapy followed by 4 weeks of oral fluoroquinolone) is recommended to prevent relapse of bacteremia. 

Although not reviewed in detail here, C. jejuni and C. coli are another major cause of inflammatory colitis that may be complicated by Guillain-Barre syndrome or reactive arthritis. In addition, their resistance to antimicrobials (particularly to quinolones) is increasing. In the United States, fluoroquinolone resistance of C. jejuni rose from 13% in 1997 to 18% in 1999 [112],... 

Only patients with severe AP complicated by necrosis should receive infection prophylaxis with broad-spectrum antibiotics. Agents that cover the range of enteric aerobic gram-negative bacilli and anaerobic organisms should be started within the first 48 hours and continued for 2 to 3 weeks. Imipenem-cilastatin (500 mg every 8 hours) may be most effective a fluoroquinolone (e.g., ciprofloxacin, levofloxacin) with metronidazole should be considered for penicillin-allergic patients. 

In complicated exacerbations where drug-resistant pneumococci, /J-lacta-mase-producing H. influenzae and M. catarrhalis, and some enteric gramnegative organisms maybe present, recommended therapy includes amox-icillin/clavulanate or a fluoroquinolone with enhanced pneumococcal activity (levofloxacin, gemifloxacin, moxifloxacin). 

In complicated exacerbations with risk of Pseudomonas aeruginosa, recommended therapy includes a fluoroquinolone with enhanced pneumococcal and P. aeruginosa activity (levofloxacin). If IV therapy is required, a /f lactamase resistant penicillin with antipseudomonal activity or a third- or fourth-generation cephalosporin with antipseudomonal activity should be used. 

Fluoroquinolones may damage growing cartilage and cause an arthropathy. Thus, these drugs are not routinely recommended for patients under 18 years of age. However, the arthropathy is reversible, and there is a growing consensus that fluoroquinolones may be used in children in some cases (eg, for treatment of pseudomonal infections in patients with cystic fibrosis). Tendinitis, a rare complication that has been reported in adults, is potentially more serious because of the risk of tendon rupture. Risk factors for tendonitis include advanced age, renal insufficiency, and concurrent... 

Ribard P, Audisio F, Kahn MF, De Bandt M, Jorgensen C, Hayem G, Meyer O, Palazzo E. Seven Achilles tendinitis including 3 complicated by rupture during fluoroquinolone therapy. J Rheumatol 1992 19(9) 1479-81. 

Complicated exacerbations Some enteric gram-negatives Fluoroquinolone with... 

Eor pregnant women with chlamydial urogenital infections, treatment can reduce the risk of pregnancy complications and transmission to the newborn significantly. Because the use of tetracyclines and fluoroquinolones is contraindicated during pregnancy, erythromycin base and amoxicillin are the recommended drug treatments (see Table 115-8). Some clinicians prefer amoxicillin to erythromycin because of better patient tolerability and, as a resulf improved patient compliance. Patients intolerant of... 

Ciprofloxacin is a fluoroquinolone antibiotic that interferes with microbial DNA synthesis. It is indicated in the treatment of infections of the lower respiratory tract, skin and skin structure, bones and joints, urinary tract gonorrhea, chancroid, and infectious diarrhea caused by susceptible strains of specific organisms typhoid fever uncomplicated cervical and urethral gonorrhea women with acute uncomplicated cystitis acute sinusitis nosocomial pneumonia chronic bacterial prostatitis complicated intra-abdominal infections reduction of incidence or progression of inhalational anthrax following exposure to aerosolized Bacillus anthracis. Cipro IV Used for empirical therapy for febrile neutropenic patients. 

Lomefloxacin, a fluoroquinolone broad-spectrum antibiotic (400 mg p.o. daily for 10 to 14 days), is used in acute bacterial exacerbations of chronic bronchitis caused by Haemophilis influenzae or Moraxella (Branhamella) catarrhalis in uncomphcated urinary tract infections (cystitis) caused by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Staphylococcus saprophyticus, in complicated urinary tract infections caused by E. coli, K. pneumoniae, P. mirabilis, and Pseudomonas aeruginosa and it is possibly effective against infections caused by Citrobacter diversus or Enterobacter cloacae and for the prophylaxis of infections after transurethral surgical procedures (see also Figure 85). 

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