Fluoroquinolones elimination

Concurrent use of the fluoroquinolones with theophylline causes an increase in serum theophylline levels. When used concurrently with cimetidine, the cimetidine may interfere with the elimination of the fluoroquinolones. Use of the fluoroquinolones with an oral anticoagulant may cause an increase in the effects of the oral coagulant. Administration of the fluoroquinolones with antacids, iron salts, or zinc will decrease absorption of the fluoroquinolones. There is a risk of seizures if fluoroquinolones are given with the NSAIDs. There is a risk of severe cardiac arrhythmias when the fluoroquinolones gatifloxacin and moxifloxacin are administered with drains that increase the QT interval (eg, quini-dine, procainamide, amiodarone, and sotalol). 

Age Renal or hepatic elimination processes are often poorly developed in newborns, making neonates particularly vulnerable to the toxic effects of chloramphenicol (see p. 320) and sulfonamides (see p. 289). Young children should not be treated with tetracyclines (see p. 311) which affect bone growth, or fluoroquinolones (see p. 323), which interfere with cartilage growth. 

In order to eliminate both dividing and non-dividing bacteria, a fluoroquinolone antibiotic, ciprofloxacin, has been associated with PIBCA and PIHCA nanospheres. In an animal model of persisting Salmonella infection, although an effect on the early phase of the infection was observed, neither free nor nanosphere-bound ciprofloxacin was able to eradicate truly persisting bacteria. ... 

Nalidixic acid, the first quinolone, first introduced in 1962, is now only rarely used and has been supplanted by the fluoroquinolones. It is almost completely absorbed from the gastrointestinal tract and is rapidly eliminated by the kidneys, resulting in urinary concentrations 4-6 times higher than plasma concentrations. There are better drugs to treat urinary tract infections. 

Payne et al. [13] used 19F MR to measure the hepatic concentration of sitafloxacin, a fluoroquinolone antimicrobial agent. Elevated liver enzymes have been reported after use of sitafloxacin, even though it is eliminated predominantly by renal excretion (>99%). This evaluation was to determine whether drug accumulation in the liver occurs. Sitafloxacin has two nonequivalent fluorines (m-oriented (I /(, 2. S ) - 2 -1 hio roc y c I o pro p y I a m i ne moiety) with resonances separated by 92 ppm. The experiments were focused only on one... 

The chemical nature and related physicochemical properties largely govern the distribution and elimination, which refers to biotransformation (metabolism) and excretion, of antimicrobial agents. The majority of antimicrobial agents are weak organic electrolytes, either weak acids (penicillins, cephalosporins, sulphonamides) or weak bases (aminoglycosides, lincosamides, macrolides, diaminopyrimidines, metronidazole), while fluoroquinolones, tetracyclines and rifampin are amphoteric compounds, and chloramphenicol and its... 

Based on current information, inhibitors of CYP 1A2 have the greatest potential for causing interactions with olanzapine. Examples include cimetidine, fluvoxamine, and fluoroquinolone antibiotics (e.g., ciprofloxacin) to varying degrees. To date, however, no serious inhibition interactions have been reported with olanzapine, which may be a result of olanzapine s wide therapeutic index. Carbamazepine has been reported to increase olanzapine elimination by as much as 50%. Cigarette smoking is a potent inducer of CYP 1A2, and one would expect lower mean olanzapine serum concentrations in smokers compared to nonsmokers. 

May cause mild CNS and GI effects and 1 bioavailability of drugs that require acidity for oral absorption (e.g., fluoroquinolones, ketoconazole). Inhibit P450 — >L elimination of diazepam, phenytoin, and warfarin. 

D. Enhancement of Elimination Enhancement of elimination is possible for a number of toxins, including manipulation of urine pH to accelerate renal excretion of weak acids and bases. For example, alkaline diuresis is effective in toxicity due to fluoride, isoniazid, fluoroquinolones, phenobarbital, and salicylates. Urinary acidiflcation may be useful in toxicity due to weak bases, including amphetamines, nicotine, and phencyclidine, but care must be taken to avoid acidosis and renal failure in rhabdomyolysis. Hemodialysis or hemoperfusion enhances the elimination of many toxic compounds, including acetaminophen, ethylene glycol, formaldehyde, lithium, methanol, procainamide, quinidine, salicylates, and theophylline. Cathartics such as sorbitol (70%) may decrease absorption and hasten removal of toxins from the gastrointestinal tract. 

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