Fluoroquinolones indications

Gram-negative cocci Non-tuberculous mycobacteria Nocardia Ceftriaxone 50 mg/mL or Ceftazidime 50 mg/mL or Fluoroquinolones 3 mg/mL Amikacin 20-40 mg/mL or Oral clarithromycin 500 mg every 12 hours Amikacin 20-40 mg/mL or Trimethoprim 16 mg/mL and sulfamethoxazole 80 mg/mL wearers as indicated... 

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. 

We then used this Caco-2 cell assay to categorize representative fluoroquinolone drug substance permeability [50], The drugs demonstrated some concentration-dependent permeability indicative of active drug transport. Based upon comparison to labetalol, ciprofloxacin was classified as a LP drug, whereas levofloxacin, lomefloxacin, and ofloxacin were classified as HP drugs, which matched their human in vivo bioavailabilities. All four fluoroquinolone drugs were subject to efflux transport (ciprofloxacin > lomefloxacin > rhodamine 123 > levofloxacin > ofloxacin). 

Foscarnet (Foscavir) [Antiviral] Uses CMV retinitis acyclovir-resistant hCTpes Infxns Action -1- Viral DNA polym ase RT Dose CMV retinitis Induction 60 mg/kg IV qSh or 100 mg/kg ql2h X 14—21 d Meant 90-120 mg/kg/dIV (Moo.-Fiti ) Acyclovir-resistant HSV Induction 40 mg/kg IV q8-12h x 14—21 d use central line -1- w/ renal impair Caution [C, —] T Sz potential w/ fluoroquinolones avoid n hrotoxic Rx (cyclosporine, aminoglycosides, ampho B, protease inhibitors) Contra CrCl <0.4 mL/min/kg Disp Inj SE Nephrotox, electrolyte abnormalities Interactions T Risks of Sz W/ quinolones t risks of n hrotox W/ aminoglycosides, amphotCTicin B, didanosine, pentamidine, vancomycin EMS Known to cause electrolyte disturbances (extremity numbness paresthesia indicates electrol5rte unbalance) monitor ECG OD May cause extremity numbing, and Szs hydrate w/ IV fluids... 

Chloramphenicol remains a major treatment of typhoid and paratyphoid fever in developing countries. However, with increasing resistance to ampicillin, trimethoprim-sulfamethoxazole and, to some extent, chloramphenicol, fluoroquinolones and some third-generation cephalosporins (e.g., ceftriaxone) have become the drugs of choice. Salmonella infections, such as osteomyelitis, meningitis and septicemia, have also been indications for chloramphenicol use. Nevertheless, antibiotic resistance patterns can be a problem. As noted previously, nonty-phoidal salmonella enteritis is not benefited by treatment with chloramphenicol or other antibiotics. 

Fluoroquinolones are a widely used family of antibiotics with a large number of indications and few side effects. More than 20 fluoroquinolones are on the market and... 

However, recent investigations on the effect of the tissue matrix on the detection limits attained by this test have indicated that ceftiofur, sulfonamides, streptomycin, and some macrolide antibiotics cannot be detected in intact meat with the plates and the bacterial strains prescribed in the European four-plate test (81, 82). Two plates of this system were not found suitable for screening sulfamethazine or streptomycin at levels far above the MRL the third plate detected tetracyclines and -lactams up to the MRL levels whereas the fourth was sensitive to -lactams and some but not all macrolides. Detection, on the other hand, of the fluoroquinolones enrofloxacin and ciprofloxacin could only be made possible by an additional Escherichia coli plate not included in the four-plate test. 

In addition to the mobile phase composition, the effect of other parameters such as temperature, flow rate, pH, and structure of the analytes were also studied, but only a few reports were available in the literature. In 1995, Lin and Maddox [66] studied the effect of temperature on the chiral resolution of amino acids and esters. The temperature was varied from 5°C to 25°C and it was reported that the resolution improved at low temperature. Hyun et al. [48-50,67] carried out the effect of temperature on the chiral resolution of amino alcohols, amines, fluoroquinolones, and other drugs. Again, lowering of temperature resulted in better resolution. The effect of temperature on the chiral resolution of phenylalanine, phenylglycine, and 2-hydroxy-2-(4-hydroxy-phenyl)-ethyl amine is shown in Table 5 [50], which indicates an increase in retention factors at lower temperature, but the best separation occurred at 20°C. These experiments indicated the exothermic nature of chiral resolution on CCE-based CSPs. Lin and Maddox [66] also studied the effect of flow rate on the chiral resolution of... 

Correct answer = B. The fluoroquinolones do not have sufficient activity against S- pneumoniae to be effective. Since they are not p-lac-tams, the fluoroquinolones are effective in treating UTIs caused by p-lactamase-producing organisms. Fluoroquinolones are also indicated for treatment of the other infections listed. 

The classification of the fluoroquinolones into generations is somewhat informal and unstandardized. However, it does serve a clinical purpose by helping to classify them on the basis of their spectra of action and indications (Table 11-9). 

Newer fourth-generation fluoroquinolones such as gati-floxacin, gemifloxacin, and moxifloxacin have improved activity against pneumococci, including macrolide- and penicillin-resistant strains, and are often termed the respiratory quinolones. They are indicated for acute exacerbations of chronic bronchitis, community-acquired pneumonia, and sinusitis. 

All the available ophthalmic fluoroquinolones are indicated for bacterial conjunctivitis with a treatment regimen of usually one to two drops four times a day. However, because the newer gatifloxacin and moxifloxacin have wider spectra and less resistance, they should probably be reserved for treatment of the more serious infection, bacterial keratitis. 

Alatrofloxacin is a fluoronaphthyridone that is hydrolysed to the active moiety, trovafloxacin, after intravenous administration. This fourth-generation broad-spectrum fluoroquinolone has activity against Gram-positive, Gram-negative, anerobic, and atypical respiratory pathogens. Because it has significant hepato-toxicity, the list of appropriate indications for trovafloxacin has been restricted. 

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