Journal of Antimicrobial Chemotherapy, Vol 40, 59-62, Copyright © 1997 by The British Society for Antimicrobial Chemotherapy
RF Grossman
Quinolones, because of their excellent pharmacokinetic properties, high
antimicrobial activity and low incidence of side-effects, have been broadly
accepted for the treatment of many infections. Because of perceived
limitations against Streptococcus pneumoniae and methicillin- resistant
Staphylococcus aureus there has been some reluctance to use them for
respiratory tract infections. Ciprofloxacin is the drug of choice for
malignant external otitis, a disease caused by Pseudomonas aeruginosa, and
it has also been used successfully for the treatment of chronic otitis
media where P. aeruginosa, S. aureus and Proteus mirabilis are main
pathogens. Quinolones are as efficacious as the beta- lactams and
cephalosporins in the treatment of acute sinusitis but most clinicians will
not use quinolones for this indication. Acute bacterial exacerbations of
chronic bronchitis respond to antimicrobial therapy and quinolones have
been demonstrated to be at least equivalent to second- and third-generation
cephalosporins, co-amoxiclav and beta- lactams. Recently published
guidelines in Canada, USA and Great Britain do not recommend quinolones for
the treatment of community-acquired pneumonia except for patients with
life-threatening disease requiring ICU admission. A quinolone in
combination with an aminoglycoside and macrolide is a regimen that can be
used as initial empirical therapy until the results of microbiological
investigations are available. For patients with severe hospital-acquired
pneumonia, where multiply resistant aerobic Gram-negative bacilli are a
consideration, a quinolone in combination with an antipseudomonal
penicillin or cephalosporin has been recommended. In the absence of P.
aeruginosa, monotherapy with a quinolone is at least as effective as third-
generation cephalosporins or imipenem. Early switch therapy from parenteral
antibiotics to oral fluoroquinolone has been demonstrated to be very
successful.
ORIGINAL ARTICLES
The role of fluoroquinolones in respiratory tract infections
Division of Respiratory Medicine, Mount Sinai Hospital, Toronto, Canada.
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