Fluoroquinolone contraindications

Discuss the uses, general drug action, contraindications, precautions, interactions, and adverse reactions of the fluoroquinolones and aminoglycosides. 

The fluoroquinolones are contraindicated in patients with a history of hypersensitivity to the fluoroquinolones, in children younger than 18 years, and in pregnant women (Pregnancy Category C). These drugs also are contraindicated in patients whose life-styles do not allow for adherence to the precautions regarding photosensitivity. 

Rifaximin appeared to be effective and safe in both adults and children. Not only do these data support the efficacy of a nonabsorbable antibiotic in the treatment of diarrhea, the lack of absorption and degree of safety reported to date support the likelihood that rifaximin will be safe to use in pregnant women. Currently, the drugs of choice for the treatment of bacterial diarrhea, especially travelers diarrhea, are the fluoroquinolones, which are contraindicated in pregnancy. While rifaximin will likely never be adequately studied in pregnancy, it should be safe. 

Rifaximin appears to be an ideal agent for the treatment of infectious watery diarrhea. It has shown excellent efficacy in numerous clinical trials of bacterial diarrhea. Its excellent side effect profile and lack of systemic absorption predict that it should be useful in treating hosts for whom the currently favored fluoroquinolones are contraindicated. Uses limited to enteric indications and its inherently low propensity to induce sustainable resistance among Gram-negative flora favor the sustained usefulness of rifaximin in the treatment of enteric syndromes. 

Fluoroquinolones Tendonitis, Achilles tendon rupture, contraindicated... 

Cephalexin is considered safe and effective. Nitrofurantoin should not be used after week 37 due to concern for hemolytic anemia in the newborn. Sulfa-containing drugs may increase risk for kernicterus in the newborn and should be avoided during the last weeks of gestation. Folate antagonists, such as trimethoprim, are relatively contraindicated during the first trimester because of their association with cardiovascular malformations. Fluoroquinolones and tetracyclines are contraindicated. 

The agent of choice depends on location. Trimethoprim-sulfamethoxazole is used for infections acquired in the United States. For infections acquired outside the United States, the agents of choice are ciprofloxacin, norfloxacin, and azithromycin. Fluoroquinolones are generally contraindicated in children and adolescents. 

Pregnant women infected with N. gonorrhoeae should be treated with either a cephalosporin or spectinomycin, because fluoroquinolones are contraindicated. Azithromycin or amoxicillin is the preferred treatment for presumed Chlamydia trachomatis infection. 

The fluoroquinolones, doxycycline, and erythromycin ethylsuccinate are contraindicated during pregnancy. 

For penicillin-allergic adults, use a fluoroquinolone (ciprofloxacin 0.5-0.75 g orally every 12 hours or 0.4 g IV every 12 hours levofloxacin 0.5-0.75 g orally or IV every 24 hours or moxifloxacin 0.4 g orally or IV every 24 hours). eGentamicin or tobramycin, 2 mg/kg loading dose, then maintenance dose as determined by serum concentrations, fluoroquinolone or aztreonam 1 g IV every 6 hours may be used in place of the aminoglycoside in patients with severe renal dysfunction or other relative contraindications to aminoglycoside use. 

Fluoroquinolones are contraindicated in children because they can cause irreversible tendon inflammation and damage. They should be used with caution... 

Contraindications Concurrent use of amiodarone, quinidine, procainamide, or so-talol history of prolonged QTc interval hypersensitivity to fluoroquinolones uncorrected electrolyte disorders (such as hypokalemia and hypomagnesemia)... 

Contraindications Hypersensitivity to other fluoroquinolones or nalidixic acid... 

Fluoroquinolones Tendonitis, Achilles tendon rupture, contraindicated in patients less than 18 years old because of effects on cartilage development... 

Contraindications Fluoroquinolones should be avoided in pregnancy, in nursing mothers and in children under 18 years of age, since articular cartilage erosion (arthropathy) occurs in immature experimental animals. 

The major groups of patients to whom contraindications may apply are patients with a history of hypersensitivity, pregnant or breastfeeding women, patients with organ dysfunction and the very old and very young. Co-morbidity and current medications may also represent a contraindication (e.g. fluoroquinolones in patients with epilepsy). 

A fluoroquinolone or azfreonam t g IV eveiy 6 hours may be used in place of the aminoglycoside in patients with severe renal dysfundion or other relative contraindications to aminoglycoside use. 

The quinolones are contraindicated in patients with a history of hypersensitivity to any drug in this family. Absorption of the fluoroquinolones is reduced by antacids, iron, and zinc salts, and thus they should not be taken concurrently. Oral ciprofloxacin and enoxacin inhibit the metabolism of theophylline, and toxicity can occur when these two drugs are administered concurrently. Oral administration of the fluoroquinolones can cause convulsions and should therefore be done with caution in patients with central nervous system disorders. These drugs are not recommended for systemic administration in children, adolescents younger than age 18 years, or pregnant women. Topical administration is contraindicated for use in patients younger than 1 year of age. 

Sparfloxacin is a fluoroquinolone with activity against the major respiratory pathogens and atypical pathogens that cause pneumonia. Photosensitivity, nausea, and diarrhea have been the most common adverse events reported in trials, and sparfloxacin is contraindicated in patients with QT interval prolongation (1). 

According to the CDC, use amoxidUin only after 10-14 days of fluoroquinolones or doxycycline treatment and only then if there are contraindications to fluoroquinolones or tetracyclines such as pregnancy, lactation, age <18 years or intolerance... 

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... 

The quinolones are contraindicated in pregrumcy. Fluoroquinolones lack activity for Treponema pallidum but have activity in vitro against N. gonorrhoeae. Chlamydia trachomatis, and Haemophilus ducreyi. For chlamydial urethritis/cervicitis, a 7-day course of ofloxacin or sparfloxacin is an alternative to a 7-day course with doxycycline or a single dose of azithromycin. 

Are there contraindications to concomitant drug use For instance, tizanidine is contraindicated in patients with concomitant use of CYP450 1A2 inhibitors such as fluvoxamine, amiodarone, mexiletine, propafenone, cimetidine, fluoroquinolones (ciprofloxacin, norfloxacin), rofecoxib, oral contraceptives, and ticlopidine [27]. 

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