Fluoroquinolone respiratory

The fluoroquinolones are used in the treatment of infections caused by susceptible microorganisms. The fluoroquinolones are effective in the treatment of infections caused by gram-positive and gram-negative microorganisms. They are primarily used in the treatment of susceptible microorganisms in lower respiratory infections, infections of the skin, urinary tract infections, and sexually transmitted diseases. Ciprofloxacin, norfloxacin, and ofloxacin are available in ophthalmic forms for infections in the eyes. 

Monitoring and Managing Adverse Drug Reactions A variety of adverse reactions can be seen with the administration of the fluoroquinolones or aminoglycosides. The nurse observes die patient, especially during the first 48 hours of tiierapy. It is important to report the occurrence of any adverse reaction to the primary health care provider before die next dose of the drug is duei If a serious adverse reaction such as a hypersensitivity reaction, respiratory difficulty, severe diarrhea, or a decided drop in blood pressure occurs, the nurse contacts die primary health care provider immediately. 

The comorbid conditions that can affect therapy and outcomes in patients with CAP include diabetes mellitus, COPD, congestive heart failure, and renal failure.27,28 If the patient has not received antibiotics in the past 3 months, then clarithromycin or azithromycin is the recommended first-line therapy by the IDSA. If the patient has received antibiotics in the last 3 months, then the IDSA recommends using either a respiratory fluoroquinolone alone or a combination of an oral P-lactam and an advanced macrolide/azalide (e.g., clarithromycin/azithromydn). The ATS recommends combination therapy or monotherapy with a respiratory fluoroquinolone for all patients with comorbidities. The p-lactam agents recommended include high-dose amoxicillin, high-dose amoxicillin-clavulanate, cefpodoxime, cefprozil, and cefuroxime. 

An advanced macrolide1 or a respiratory fluoroquinolone A respiratory fluoroquinolone0 alone or an advanced macrolide plus a /J-ladame... 

Amoxicillin-clavulanate or clindamycin A /J-lactame or a respiratory fluoroquinolone... 

An advanced macrolide plus a /J-lactam or a respiratory fluoroquinolone alone (regimen selected will depend on nature of recent antibiotic therapy)... 

Either (a) an antipseudomonal agent plus ciprofloxacin, or (b) an antipseudomonal agent plus an aminoglycoside plus a respiratory fluoroquinolone or a macrolide... 

Immediate-lype hypersensitivity Clarithromycin or azithromycin or trimetiioprim-sulfamelhoxazole or doxycycline or respiratory fluoroquinolone (levofloxacin or gatifloxacin). 

High-dose amoxicillin with clavulanate or /J-lactamase-stable cephalosporin. Second choice respiratory fluoroquinolone. 

Because of its pharmacokinetic features (pronounced bioaccessability upon oral use, diffusion to tissues and permeation into them, broad spectrum of antibacterial activity, and so on), fluoroquinolones have considerable potential for treating infections of practically any anatomic localization. Fluoroquinolones are very effective in treating infections of the respiratory tract, urinary tract, bones, skin, soft tissues, and so on. 

Therapeutic uses of the quinolones include urinary and respiratory tract infections, GI and abdominal infections, STDs, and bone, joint, and soft tissue infections. Nalidixic acid is effective for urinary tract infections however, bacteria can become resistant, particularly if the drug is used for long periods. The second-generation fluoroquinolones are all equally efficacious in UTIs, and their activity is comparable to that of TMP-SMX. These drugs have shown efficacy in treating prostatitis and can serve as an alternative therapy for patients not responding to TMP-SMX. 

It is the levoisomer of ofloxacin and having better activity than ciprofloxacin and ofloxacin against S. pneumoniae. It is also used in chronic bronchitis, sinusitis, pyelonephritis, and other related infections of soft tissues. Due to high oral bioavailability, patient can be shifted from IV to oral therapy. It can be administered just once a day regimen as an alternate to other fluoroquinolones in the treatment of respiratory infections. 

Levofloxacin, gatifloxacin, gemifloxacin, and moxifloxacin, so-called respiratory fluoroquinolones, with their enhanced gram-positive activity and activity against atypical pneumonia agents (eg, chlamydia, mycoplasma, and legionella), are effective and used increasingly for treatment of upper and lower respiratory tract infections. 

Levofloxacin Oral, IV l -isomer of ofloxacin once-daily dosing renal clearance "respiratory" fluoroquinolone with improved activity versus pneumococcus... 

Moxifloxacin Oral, TV "respiratory" fluoroquinolone once-daily dosing improved activity versus anaerobes and Mycobacterium tuberculosis hepatic clearance results in lower urinary levels so use in urinary tract infections is not recommended... 

The main application of fluoroquinolones has been for gastrointestinal and respiratory infections. The US Food and Dmg Administration has approved the therapeutic use of saratloxacin in poultry, making this the first approved fluroqui-nolone in food animals (137). Other members of this class of drugs have been petitioned for similar use. Although not approved for use in treatment of infections in cows, enrofloxacin is the most commonly used fluroquinolone in the European Union (138). 

Danofloxacin is a fluoroquinolone antibacterial developed specifically for use in veterinary medicine (140). It has been studied for use in cattle, swine, chickens, and turkeys for the control of respiratory and enteric bacterial infections (141). Danofloxacin can be administered via drinking water to broiler chickens and replacement chicks at a dosage of 5 mg/kg bw for 3 days, and via the intramuscular route to calves, beef, and nonlactating cattle at a dosage of 1.25 mg/kg bw/ day for 3 days. 

Marbofloxacin is a new fluoroquinolone intended for treatment of bovine respiratory disease by the oral or parenteral route, and for treatment of the mastitis-metritis-agalactia syndrome in pigs by the parenteral route. The proposed dosage rate is 2 mg/kg bw/day for up to 5 days. 

Moxifloxacin has a broad spectrum of activity which includes Gram-positive cocci, atypical pathogens and anaerobic bacteria responsible, inter alia, for infections of the respiratory tract. Moreover, moxifloxacin is one of the most effective fluoroquinolones against pneumococci, including the penicillin- and macrolide-resistant strains. The development of resistance to moxifloxacin is slower than that of the other fluoroquinolones. 

Zhanel GG, et al. A critical review of the fluoroquinolones focus on respiratory infections. Drugs, 2002, 62, 13-59. 

Yoshizumi S, et al. In vivo activity of HSR-903, a new fluoroquinolone, against respiratory pathogens. Antimicrob. Agents Chemother., 1998, 42, 785-788. 

Agents Chemother., 1998, 42, 703-704. Biedenbach DJ, et al. BAY 12-8039, a novel fluoroquinolone. Activity against important respiratory tract pathogens. Diagn. Microbiol. Infect. Dis., 1998, 32, 45-50. 

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