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Quinolones for the treatment of skin, soft tissue, bone and prosthetic joint infections

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Fluoroquinolone Antibiotics

Part of the book series: Milestones in Drug Therapy ((MDT))

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Abstract

The antimicrobial spectrum of activity of the early quinolones (i.e., norfloxacin, ofloxacin, ciprofloxacin) favor potency against Gram-negative microorganisms [1, 2]. The newer agents (levofloxacin, gatifloxacin, moxifloxacin) have expanded activity against the Gram-positive microorganisms [3, 4] and some of these newer agents which are currently available or in clinical trial (moxifloxacin, gatifloxacin, garenoxacin) also demonstrate excellent in vitro activity against the Gram-negative, Gram-positive, anaerobic, and atypical microorganisms [5-7]. Ciprofloxacin and levofloxacin have only moderate activity against the group A streptococci, with MIC90s of 0.5 pg/ml, however, reports of resistance to these agents have been rare [8, 9]. In a nationwide multicenter susceptibility surveillance study in Spain [10], 70 (3.4%) of 2,039 isolates of Streptococcus pyogenes had a ciprofloxacin MIC >_ 4 pg/ml. These microorganisms were found to be equally distributed between children and adults [10]. The early investigations with the then new fluoroquinolones, particularly ciprofloxacin, demonstrated in vitro activity against both methicillinsusceptible Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA), although the activity was marginal with MIC90s of 0.5 pg/ml [11, 12]. A single mutation in the primary target would increase the MIC of ciprofloxacin four-to 16-fold, a level of resistance at or above peak drug concentrations achievable in serum, providing an opportunity for such first-step mutants to survive and emerge when a patient was exposed to fluoroquinolones [13]. Fluoroquinolone resistance in MRSA and the coagulase-negative staphylococci is now >50% worldwide [14-16]. Fluoroquinolone resistance in methicillin-susceptible staphylococci vary from <5% to 22%, depending on the location of the study [17, 18]. An international study with isolates provided from countries in Europe, Asia, and Latin America demonstrated ciprofloxacin resistant rates in MRSA, MSSA, methicillin-resistant and -susceptible coagulase-negative staphylococci of 90%, 21%, 50% and 22% respectively [15]. Susceptibility testing was carried out

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  1. Infection Control Unit, Health Sciences Centre, MS 673-820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada

    John M. Embil

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  1. Faculty of Medicine, The University of Manitoba, 409 Tacho Avenue, Winnipeg, Manitoba, R2H 2A6, Canada

    Allan R. Ronald

  2. Microbiology Laboratory, Mt. Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada

    Donald E. Low

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Embil, J.M. (2003). Quinolones for the treatment of skin, soft tissue, bone and prosthetic joint infections. In: Ronald, A.R., Low, D.E. (eds) Fluoroquinolone Antibiotics. Milestones in Drug Therapy. Birkhäuser, Basel. https://doi.org/10.1007/978-3-0348-8103-6_12

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  • DOI: https://doi.org/10.1007/978-3-0348-8103-6_12

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