Fluoroquinolones - Antibiotics Class Overview
Mechanism: DNA Gyrase and Topoisomerase inhibitors bactericidal
Side effects: QT prolongation (recent NEJM article suggested increased risk of cardiovascular death with Levofloxacin, but not Ciprofloxacin), tendon rupture (esp if on steroids), GI intolerance, cartilage damage, rare dysglycemias (Gatifloxacin removed from market for this reason), dizziness/HA’s, rashes, teratogenicity, transaminitis. Fluoroquinolones also recently associated with increased risk of retinal detachment. High rate of c.diff.
- Fluoroquinolones also have excellent TB coverage (Moxifloxacin > Levofloxacin > Ciprofloxacin). If patient has PNA, but suspect TB, do not use FQ’s!!(Do not want to use monotherapy against TB à will develop resistance)
- All fluoroquinolones have atypical coverage (but Cipro – relatively weaker against Chlamydia and Mycoplasma, but good vs Legionella).
- All fluoroquinolones have excellent bioavailability (except Norfloxacin), so use PO whenever possible.
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