Preserving the efficacy of front-line fluoroquinolones through selective use to optimise clinical outcomes.
As antibiotic resistance is increasing worldwide, it is important to prescribe fluoroquinolone (FQ) antibiotics appropriately for a given infection to preserve class efficacy. Clinical studies reveal good efficacy and tolerability of the currently approved FQs (ciprofloxacin, levofloxacin and moxifloxacin) in a wide range of community- and hospital-acquired infections. However, certain features supporting their clinical efficacy suggest a rationale for inclusion of moxifloxacin and ciprofloxacin with complementary clinical benefit on a formulary rather than levofloxacin alone; it may also be more cost-effective. Ciprofloxacin has advantages over levofloxacin in the treatment of Gram-negative infections, whilst moxifloxacin has certain efficacy and ease of use advantages over levofloxacin in respiratory tract infections. To preserve the potential of FQs and to minimise the risk of resistance selection, agents with the highest in vitro activity and supportive pharmacokinetic/pharmacodynamic profiles should be used first-line, as appropriate for local guidelines and prescribing information.
Institute for Clinical Pharmacology and Toxicology, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Berlin, Germany. Electronic address: haloheck@zedat.fu-berlin.de.
Hartmut M
HM
Lode
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects*; D001424:Bacterial Infections / Q000188:drug therapy*; D024881:Drug Resistance, Bacterial; D004358:Drug Therapy / Q000592:standards*; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones
Antimicrobial therapy; Clinical efficacy; Fluoroquinolones; Resistance; Safety; Susceptibility