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A review on the impact of 4-quinolones on the normal oropharyngeal and intestinal human microflora

Einfluß der 4-Chinolone auf die normale oropharyngeale und intestinale Flora des Menschen. Übersicht

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During the last few years the impact of the newer 4-quinolones, ciprofloxacin, enoxacin, norfloxacin, ofloxacin and pefloxacin, on the human microflora has been studied by several investigators. This review article summarizes the published data concerning these studies. The results show that the oropharyngeal flora is affected only slightly or not at all by the 4-quinolones. All the newer 4-quinolones have a similar effect on the normal intestinal flora. The gram-negative aerobic flora is strongly suppressed during administration of 4-quinolones, while the gram-positive flora is only slightly affected. The anaerobic microflora is hardly affected at all. The emergence of resistant bacterial strains is uncommon, although one study shows increased MIC-values for anaerobes during ciprofloxacin administration. Replacement by yeasts or other inherently resistant microorganisms does not often seem to be a problem. High concentrations of the 4-quinolones are reached in faeces, values between 100–2,200 mg/kg being reported. Since the 4-quinolones do not cause marked ecological disturbances in the intestinal microflora, they may be suitable for selective decontamination in immunocompromised patients, for prophylaxis of urinary tract infections and for treatment of bacterial intestinal infections.


In den vergangenen Jahren wurden mehrere Untersuchungen zur Beeinflussung der menschlichen Mikroflora durch die neuen 4-Chinolone Ciprofloxacin, Enoxacin, Norfloxacin, Ofloxacin und Pefloxacin durchgeführt. Die vorliegende Übersichtsarbeit faßt die aus diesen Studien publizierten Daten zusammen. Die Ergebnisse zeigen, daß 4-Chinolone die oropharyngeale Flora und auch die normale Darmflora kaum oder überhaupt nicht verändern. Unter der Therapie mit 4-Chinolonen ist die aerobe gramnegative Flora stark supprimiert, die grampositive Flora dagegen kaum beeinträchtigt. Die anaerobe Mikroflora wird kaum verändert. Nur selten treten resistente Bakterienstämme auf. In einer Studie wurden allerdings unter Behandlung mit Ciprofloxacin erhöhte MHK-Werte für Anaerobier festgestellt. Zu einer Verdrängung der normalen Flora zugunsten von Hefen oder anderen Mikroorganismen mit inhärenter Resistenz kommt es offensichtlich nur selten. 4-Chinolone werden in hoher Konzentration in den Faeces gefunden, die publizierten Konzentrationen liegen zwischen 100 und 2200 mg/kg. Da die 4-Chinolone die Ökologie der Mikroflora des Darmes nicht wesentlich beeinträchtigen, eignen sie sich möglicherweise für die selektive Dekontamination bei abwehrgeschwächten Patienten, die Prophylaxe von Harnwegsinfektionen und Behandlung intestinaler bakterieller Infektionen.

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  1. 1.

    van der Waaij, D., Berghuis-de Vries, I. M., Lekkerkerk van der Wees, J. E. C. Colonization resistance of the digestive tract in conventional and antibiotic-treated mice. J. Hyg. 69 (1971) 405–411.

  2. 2.

    van der Waaij, D. Colonization pattern of the digestive tract by potentially pathogenic microorganisms: Colonization-controling mechanisms and consequences for antibiotic treatment. Infection 11, Suppl. 2 (1983) 90–92.

  3. 3.

    Nord, C. E., Kager, L., Heimdahl, A. Impact of antimicrobial agents on the gastrointestinal microflora and the risk of infections. Am. J. Med. 76 (1984) 99–106.

  4. 4.

    Nord, C. E., Heimdahl, A., Kager, L., Malmborg, A. S. The impact of different antimicrobial agents on the normal gastrointestinal microflora of humans. Rev. Inf. Dis. 6 (1984) 270–275.

  5. 5.

    Heimdahl, A., Nord, C. E. Colonization of the oropharynx with pathogenic microorganisms — a potential risk factor for infection in compromised patients. Chemotherapy 4 (1985) 186–191.

  6. 6.

    Knothe, H.: In vitro activity of gyrase inhibitors. Quinolones Bulletin, October (1984).

  7. 7.

    Wolfson, J. S., Hooper, D. C. Minireview: the fluoroquinolones: structures, mechanisms of action and resistance, and spectra of activityin vitro. Antimicrob. Agents Chemother. 28 (1985) 581–586.

  8. 8.

    Shannon, K., Phillips, I. The antimicrobial spectrum of the quinolones. Clin. Res. Forum 7 (1985) 29–36.

  9. 9.

    Brumfitt, W., Franklin, I., Grady, D., Hamilton-Miller, J. M. T., Iliffe, A. Changes in the pharmacokinetics of ciprofloxacin and fecal flora during administration of a 7-day course to human volunteers. Antimicrob. Agents Chemother. 26 (1984) 757–761.

  10. 10.

    Rozenberg-Arska, M., Dekker, A. W., Verhoef, J. Ciprofloxacin for selective decontamination of the alimentary tract in patients with acute leukemia during remission induction treatment: The effect on fecal flora. J. Infect. Dis. 152 (1985) 104–107.

  11. 11.

    Enzensberger, R., Shah, P. M., Knothe, H. Impact of oral ciprofloxacin on the faecal flora of healthy volunteers. Infection 13 (1985) 273–275.

  12. 12.

    Bergan, T., Delin, C., Johansen, S., Kolstad, I. M., Nord, C. E., Thorsteinsson, S. B. Pharmacokinetics of ciprofloxacin and effect of repeated dosage on salivary and faecal microflora. Antimicrob. Agents Chemother. 29 (1986) 298–302.

  13. 13.

    van Saene, J. J. M., van Saene, H. K. F., Geitz, J. N., Tarko-Smit, N. J. Ph., Lerk, C. F. Quinolones and colonization resistance in human volunteers. Pharm. Weekbl. (Sci.) 8 (1986) 67–71.

  14. 14.

    Holt, H. A., Lewis, D. A., White, L. O., Bastable, S. Y., Reeves, D. S. Efect of oral ciprofloxacin on the faecal flora of healthy volunteers. Eur. J. Clin. Microbiol. 5 (1986) 201–205.

  15. 15.

    Esposito, S., Barba, D., Galante, D., Gaeta, G. B., Laghezza, O.: Intestinal microflora changes induced by ciprofloxacin and treatment of portal-systemic encephalopathy. Rev. Infec. Dis. (1987) in press.

  16. 16.

    Edlund, C., Lidbeck, A., Kager, L., Nord, C. E. Effect of enoxaxin on colonic microflora of healthy volunteers. Eur. J. Clin. Microbiol. 6 (1987) 298–300.

  17. 17.

    Meckenstock, R., Haralambie, E., Linzenmeier, G., Wendt, F. Die Beeinflussung der Darmflora durch Norfloxacin bei gesunden Menschen. Z. Antimikr. Antineoplast. Chemother. 1 (1985) 27–34.

  18. 18.

    Schaeffer, A. J., Sisney, G. A. Efficacy of norfloxacin in urinary tract infetions: biological effects on vaginal and fecal flora. J. Urol. 133 (1985) 628–630.

  19. 19.

    De Vries-Hospers, H. G., Welling, G. W., van der Waaij, D. Norfloxacin for selective decontamination. A study in human volunteers. Prog. Clin. Biol. Res. 181 (1985) 259–262.

  20. 20.

    Leigh, D. A., Emmanuel, F. X. S., Tighe, C., Hancock, P., Boddy, S.: Pharmacokinetic studies of norfloxacin in healthy volunteers and effect on the faecal flora. In:Joji Ishigami (ed.): Recent Advances in Chemotherapy. Antimicrobial Section 2. Proc. 14th International Congress of Chemotherapy, Kyoto 1985, pp. 1835–1836.

  21. 21.

    Pecquet, S., Andremont, A., Tancrède, C. Selective antimicrobial modulation of the intestinal tract by norfloxacin in human volunteers and in gnotobiotic mice associated with a human faecal flora. Antimicrob. Agents Chemother. 29 (1986) 1047–1052.

  22. 22.

    Edlund, C., Bergan, T., Josefsson, K., Solberg, R., Nord, C. E. Effect of norfloxacin on human oropharyngeal and colonic microflora and multiple-dose pharmacokinetics. Scand. J. Infect. Dis. 19 (1987) 113–121.

  23. 23.

    Cofsky, R. D., du Bouchet, L., Landesman, S. H. Recovery of norfloxacin in feces after administration of a single oral dose to human volunteers. Antimicrob. Agents Chemother. 26 (1984) 110–111.

  24. 24.

    Pecquet, S., Andremont, A., Tancrède, C.: Effect of ofloxacin on fecal bacteria in human volunteers. Antimicrob. Agents Chemother. (1987) in press.

  25. 25.

    Chida, T., Shibaoka, H., Ishizuka, I., Nakaya, R. The effect of ofloxacin (DL8280), a new antibacterial agent of pyridone-carboxylic acid derivative, on human fecal flora. Chemotherapy 32 (1984) 109–117.

  26. 26.

    van Saene, J. J. M., van Saene, H. K. F., Tarko-Smit, N. J. Ph., Lerk, C. F.: Suppression of intestinal flora by pefloxacin in human volunteers. Rev. Infec. Dis. (1987) in press.

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Edlund, C., Nord, C.E. A review on the impact of 4-quinolones on the normal oropharyngeal and intestinal human microflora. Infection 16, 8–12 (1988). https://doi.org/10.1007/BF01646921

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  • Ofloxacin
  • Norfloxacin
  • Pefloxacin
  • Enoxacin
  • Selective Decontamination