
Fluoroquinolones are
bactericidal agents for growing bacteria. It is related to nalidixic acid. The
mechanism of action of this popular class of antibiotics is by inhibiting DNA
gyrase and inhibition of DNA type IV topoisomerase. They basically interfere
with DNA replication. These agents are highly active against Enterobacteriaceae,
Pseudomonas aeruginosa, Salmonella bacteremia, Shigella, Neisseria, Haemophilus
influenzae, Chlamydia, Mycobacterium tuberculosis, Chlamydophila, Moraxella
catarrhalis, Mycoplasma pneumoniae, Legionella pneumophila and Campylobacter.
These fluoroquinolones are
classified by generation based on their antimicrobial activities. Brand names
of these agents may vary depending on country.
First-generation agents are not often used today. They are
indicated for uncomplicated lower urinary tract infections given through oral
administration for 7 days. They have restrained gram-negative reactions and inconsequential
systemic distribution. Patients suffering from liver disease should take these
medicines with precaution.
- Nalidixic acid
*Reported
side effects with this drug are cranial nerve palsy, metabolic acidosis and
toxic psychosis.
- Cinoxacin
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Generic name
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Brand Names
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Nalidixic Acid
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NegGram
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Uriben
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Cinoxacin
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Cinoxacin
Cinobac
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Uriben
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Second-generation agents are very active in treating diseases
caused by aerobic gram-negative bacilli but have narrow gram-positive activity.
Class I
Class I agents of this
generation are indicated for urinary tract infections.
- Lomefloxacin
- Enoxacin
- Norfloxacin
*Patients should definitely avoid driving or
skilled activities when taking
Norfloxacin as it prejudice performance with the said tasks. 400 mg of this drug should be given twice a
day for 7 – 10 days. If in case the
urinary tract infection is uncomplicated, Norfloxacin is given for 3 days only. Chronic relapsing of
UTI may occur; in this case 400mg twice
daily of Norfloxacin is given up to 12 weeks. If suppression of the infection is acceptable then the dosage may reduce to 400 mg once a day for 4 weeks.
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Generic Names
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Brand Names
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Lomefloxacin
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Maxaquin
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Enoxacin
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Penetrex
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Norfloxacin
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Noroxin
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Norfloxacin (non-proprietary)
Utinor
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Euroflox
Fasqilon
Jaydisyn
Norex
Urithracin
Utiflox
Winaflox
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Class II
Class II agents are used
to target infections such as complicated urinary tract infections, Nosocomial
infections, Gastroenteritis, Prostatitis, and sexually transmitted diseases.
Class I of these agents are given orally while Class II can be given orally or
intravenously.
- Ciprofloxacin
*Effects
of Ciprofloxacin are enhanced by alcohol.
- Ofloxacin
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Generic Names
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Brand Names
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Ciprofloxacin
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Cipro
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Ciprofloxacin (Non-proprietary)
Ciproxin
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Ciloxan
Ciprobay
Cipromax
Cipromet
Qinoflox
Xipro
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Ofloxacin
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Floxin
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Ofloxacin (Non-proprietary)
Tarivid
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Inoflox
Imoflox
Qinolon
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Third-generation agents have a wider gram-negative and atypical
intracellular activity. They also have enhanced reaction against gram-positive spectrum.
They gave a higher serum concentration making it more effective against
bacteria like Enterobacteriaceae, Streptococci and other atypical pathogens. They
have similar indication as the Class II of second generation antibiotics except
that they can be given to hospitalized or non-hospitalized patients with
community-acquired pneumonia. These can also be given in patients suffering
from exacerbated chronic bronchitis in which patients are not responding to
other antibacterial agents. These agents are administered orally and
intravenously.
- Moxifloxacin
- Levofloxacin
Some
side effects that can be seen with the use of Levofloxacin are hypoglycaemia,
flatulence, constipation, sometimes tachycardia and very rarely pneumonitis.
This medication reacts adequately in acute sinusitis with 500 mg daily
oral dose for 10-14 days. For some complicated UTI, 250 mg daily by intravenous
infusion is given and may be increased in severe infections.
- Sparfloxacin
- Gatifloxacin
*Gatifloxacin
was withdrawn due to increased frequency of hypoglycaemia and hyperglycemia.
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Generic Names
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Brand Names
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Moxifloxacin
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Avelox
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Avelox
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Avelox
Vigamox
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Levofloxacin
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Levaquin
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Tavanic
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Levox
Levocin
Pravox
Wilovex
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Sparfloxacin
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Zagam
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Gatifloxacin (Withdrawn)
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Tequin
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Fourth-generation antibiotic inhibits both DNA gyrase and
topoisomerase which enables the slowing down of resistance development. It is
consider in treating intra-abdominal infections. This antibiotic can be
provided through oral and intravenous administration.
- Trovafloxacin
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Generic Names
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Brand Names
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Trovafloxacin
(Withdrawn)
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Trovan
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There are some precautions to watch
out in using quinolones. Among the occasional adverse effects that may arise
are headache, dizziness, insomnia, diarrhea, nausea, dyspepsia, hypoglycaemia,
tendonitis, photosensitivity and effects on central nervous system. In some
cases, rashes, hallucinations, tremor, leukopenia, and urticarial may occur to
patients taking these antibiotics. Quinolones are contraindicated in patients
with a history of tendon disorders related to quinolone use. Drug dosage forms of antibiotics may differ considering the site of infection
and the age of the patient to take the medication.
References:
Merck Manuals
British National Formulary
56
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