Journal of Antimicrobial Chemotherapy (2001) 47, 893
© 2001 The British Society for Antimicrobial Chemotherapy
Correspondence |
Conventional dogma applied to quinolones? Time for a change
The JONES Group and JMI Laboratories, 345 Beaver Kreek Center, Suite A, North Liberty, IA 52317, USA
Sir,
I found the recent leading article by Cubbon & Masterton1 to be a refreshing and very honest appraisal of the clinical role of newer quinolones. The authors present a comprehensive list of relevant evidence-based studies that assess the risks and potential values of this antimicrobial class.
Like these authors, I urge that specialists in medical microbiology and infectious diseases do not discard this series of antimicrobials because of the poor performance of earlier structurally related products, some with unacceptable rates of adverse events.2,3 Several compounds have recently been introduced into clinical practice (gatifloxacin, moxifloxacin) or are near regulatory release (gemifloxacin), each clearly offering therapeutic advantages for the treatment of commonly encountered respiratory tract pathogens (Streptococcus pneumoniae, atypical organisms and others). These compounds also possess physico-chemical properties that could minimize emerging resistances.4
Although prevailing dogma continues to dictate the limited utilization of newer anti-infectives, particularly in this class, or the ‘saving of such agents until clinically needed’, a dramatic reappraisal seems to be in order when considering the quinolones. Could the evidence be: (i) that newer agents truly can be better; (ii) that clinical outcomes can be improved with their use; (iii) that resistances can be minimized or controlled; and (iv) that the total medical cost burden could be reduced by the newer drug?5 This may well be the case for these newer quinolones; time and observational clinical experience will dictate!
I urge that experts in anti-infective chemotherapy and primary care providers alike be open to evidence-based therapeutic options that could include the expanded, structured use of newer and sometimes structurally different (des-fluoro series) quinolones.6 Articles such as that by Cubbon & Masterton,1 promoted by this Journal, have done a great service in challenging our contemporary thinking and continue our logical understanding of this complex but valuable class of antimicrobials.
Notes
J Antimicrob Chemother 2001; 47: 893
* Tel: +1-319-665-3370; Fax: +1-319-665-3371; E-mail: ronald-jones{at}jonesgr.com 
References
1
.
Cubbon, M. D. & Masterton, R. G. (2000). New quinolones—a fresh answer to the pneumococcus. Journal of Antimicrobial Chemotherapy 46, 869–72.
2 . Ball, P., Mandell, L., Niki, Y. & Tillotson, G. (1999). Comparative tolerability of the newer fluoroquinolone antibacterials. Drug Safety 21, 407–21.[Web of Science][Medline]
3 . File, T. M., Segreti, J., Dunbar, L., Player, R., Kohler, R., Williams, R. R. et al. (1997). A multicentre, randomized study comparing the efficacy and safety of intravenous and/or oral levofloxacin versus ceftriaxone and/or cefuroxime axetil in treatment of adults with community-acquired pneumonia. Antimicrobial Agents and Chemotherapy 41, 1965–72.[Abstract]
4
.
Drugeon, H. B., Juvin, M. E. & Bryskier, A. (1999). Relative potential for selection of fluoroquinolone-resistant Streptococcus pneumoniae strains by levofloxacin: comparison with ciprofloxacin, sparfloxacin and ofloxacin. Journal of Antimicrobial Chemotherapy 43, Suppl. C, 55–9.
5 . Pechere, J.-C. & Lacey, L. (2000). Optimizing economic outcomes in antibiotic therapy of patients with acute bacterial exacerbations of chronic bronchitis. Journal of Antimicrobial Chemotherapy 45, Topic T2, 19–24.[Abstract]
6
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Takahata, M., Mitsuyama, J., Yamashiro, Y., Yonezawa, M., Araki, H., Todo, Y. et al. (1999). In vitro and in vivo antimicrobial activities of T-3811ME, a novel des-F(6)-quinolone. Antimicrobial Agents and Chemotherapy 43, 1077–84.
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