Quinolones are a fairly new category of antimicrobial drugs used to treat a wide range of infections. NegGram was the first quinolone approved in the United States for human use in 1962. Since its introduction, second- , third-, and fourth-generations have been introduced. Nine fluoroquinolones have been approved for human use.
Importance
The newer fluoroquinolones are better absorbed and treat a wider variety of gram-negative and gram-positive organisms. They last longer in the system, meaning that only one or two daily doses are needed in many cases. Judicious use is required to prevent mutations that allow for the development of "super bugs;" that is, infections that have become antibiotic resistant.
Conditions Treated with Quinolones
A wide variety of infections are treated with quinolones, including respiratory diseases such as acute sinusitis, bronchitis and pneumonia. Care must be used when treating sinusisitis with quinolones as there is potential to develop bacterial resistance. Quinolones are usually not used as first-line treatments in sinusitis.
Some sexually transmitted diseases respond to quinolone therapy. Other infections which may be treated with quinolones are diabetic foot infections, urinary tract infections, kidney infections and prostatitis
Use in Biologic Warfare
Certain quinolones are used to treat anthrax, with Cipro given after exposure to anthrax to prevent infection. Quinolones also prevent or treat cholera, plague and brucellosis. Few drugs are effective for the threat of biological warfare.
Side Effects
Like most antibiotics, the most common side effects of quinolones include headache, dizziness, and drowsiness. These symptoms occur in about 2 percent to 20 percent of patients. Side effects are usually mild but can be serious in certain populations.
Serious side effects are rare but should be taken into account by the prescribing physician. Quinolones may trigger fatal heart arrhythmias in patients at high risk for arrhytmias. Raxar was taken off the market in 1999 due to its potential for torsades de pointes, a fatal ventricular arrhythmia.
Other serious side effects include seizures, anaphylactic shock and Steven-Johnson syndrome.
Drug Interactions
Serious drug interactions may occur while using quinolones. Many over-the-counter supplements, such as calcium, iron, antacids and nutritional supplements, taken within four hours of quinolone can reduce the concentration of the drug by up to 90 percent.
Many drugs combined with quinolones increase increase drug levels and the effects of that drug. Dosages of many drugs may need to be adjusted when on quinolone therapy. Theophylline levels may become toxic. Digoxin and coumadin levels may be increased and require dosage adjustment.
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