Clinical role of the quinolones today and in the future

Waldvogel, Francis

doi:10.1007/bf01975174

Cited by 11 publications

(7 citation statements)

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“…typhi. Third generation cephalosporins and quinolones have recently been used for the treatment of both typhoid fever and chronic enteric carriers and found to be useful for these indications (Bryan, Rocha & Scheld, 1986;Soe & Overturf, 1987;Murray, 1989;Waldvogel, 1989). Again, an important factor in the efficacy of these antibiotics is probably their good intracellular bioactivity.…”

Section: Discussionmentioning

confidence: 99%

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Effects of ampicillin, ceftriaxone, chloramphenicol, pefloxacin and trimethoprim-sulphamethoxazole on Salmonella typhi within human monocyte-derived macrophages

Chang

Vladoianu

Péchère

1990

J Antimicrob Chemother

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The killing effect of various antimicrobial agents used in the therapy of Salmonella typhi infection was tested against Salm. typhi strain Ty2 after phagocytosis by human monocyte-derived macrophages. The macrophages, cultured in 96-well microtitre plates, were infected for 1 h at 37°C by opsonized Salm. typhi Ty2 at a bacteria-cell ratio of 9:1. When added to the infected macrophage monolayers, at one and ten times the MIC, ampicillin, ceftriaxone and pefloxacin appeared to be highly bactericidal ( < 0-25 log l0 cfu/well after 20 h, against 4 log 10 cfu/well in antibiotic-free controls). Trimethoprim-sulphamethoxazole was bactericidal at ten times the MIC, but not at the MIC. Chloramphenicol was mostly bacteriostatic at the concentrations tested. As a control, gentamicin (10mg/l) did not exhibit any significant antibacterial effect, indicating that most or all the bacteria recovered from lysed cells were intracellular. Other controls for phagocytosis were also performed with heat-killed Candida albicans. Our results seem to correlate with the known clinical effect of some antimicrobials in human Salm. typhi infection. The in-vitro assay described here may be useful for assessing the activity of antimicrobial agents against Salm. typhi infection.

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Section: Discussionmentioning

confidence: 99%

“…typhi carrier state, as observed with chloramphenicol, they may be playing a major role in blocking secondary transmission of Salm. typhi and thereby preventing outbreaks of typhoid fever (Bryan et al, 1986;Soe & Overturf, 1987;Murray, 1989;Waldvogel, 1989). …”

Section: Discussionmentioning

confidence: 99%

Effects of ampicillin, ceftriaxone, chloramphenicol, pefloxacin and trimethoprim-sulphamethoxazole on Salmonella typhi within human monocyte-derived macrophages

Chang

Vladoianu

Péchère

1990

J Antimicrob Chemother

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“…Numerous clinical studies have demonstrated the remarkable efficacy and safety of these compounds in the treatment of various infections in adult patients (1,2). Compared to nalidixic acid, these new quinolones have an enlarged antimicrobial spectrum, greatly enhanced bactericidal activity, and substantialpharmacokinetie advantages.…”

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confidence: 99%

Use of quinolones in pediatrics

Schaad

1991

Eur. J. Clin. Microbiol. Infect. Dis.

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Compared to nalidixic acid, the new quinolones possess an enlarged antimicrobial spectrum, greatly enhanced bactericidal activity, and substantial pharmacokinetic advantages. Because their activity against streptococci is limited the quinolones presently available will never be included in routine regimens for children. Moreover, adequate pharmacokinetic studies are still lacking in pediatrics, and potential drug toxicity warrants further long-term monitoring. Nevertheless, various studies strongly suggest that there is no quinolone-induced cartilage toxicity in humans, and the results of published clinical trials with fluoroquinolones in pediatric patients show promising efficacy and safety. From a review of the available data it is concluded that use of the quinolones in children should be limited to specific infections which are usually caused by Pseudomonas aeruginosa, Staphylococcus aureus or Staphylococcus epidermidis, and are complicated by underlying pathologic or special conditions such as cystic fibrosis or urologic abnormality. In each case, careful monitoring to determine efficacy, potential adverse effects including drug-drug interaction and toxicity, and any emergence of bacterial resistance is mandatory.

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“…The fluoroquinolones are highly effective in the treatment of acute bacterial diarrhoea (Ericsson et al 1987;Wistrom et al 1989); owing to their broad antibacterial spectrum they can be administered without prior identification of the pathogen and, by eradicating the intestinal pathogen, they prevent development of the carrier state and secondary transmission (Du Pont et al 1987;Waldvogel 1989). They are also effective prophylactically (Rademaker et al 1989;Scott et al 1990;Wistrom et al 1987), although they are not routinely recommended for this use.…”

Section: Gastrointestinal Infectionsmentioning

confidence: 99%

“…Acute exacerbation of pulmonary infections in patients with cystic fibrosis is likely to be the main indication for use of fluoroquinolones in respiratory disease (Scully et al 1987;Waldvogel 1989). Therapeutic sputum levels of these agents exceed by a factor of 4 to 5 the M1C90 values for mucoid P. aeruginosa, and oral ofloxacin, ciprofloxacin and norfloxacin have proven as effective as parenteral antipseudomonal therapy in these patients (Hodson et al 1987;Jensen et al 1987).…”

Section: Respiratory Tract Infectionsmentioning

confidence: 99%

The Quinolones

Fitton¹

1992

Clinical Pharmacokinetics

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The fluoroquinolones represent a relatively new class of antibiotics with outstanding therapeutic potential, attributable to their broad spectrum of antimicrobial activity and favourable tissue distribution. They are highly active against most Gram-negative pathogens, as well as Staphylococcus aureus and coagulase-negative staphylococci. In addition, the fluoroquinolones have useful pharmacokinetic properties: they are orally active, and their Iipophilicity and low degree of plasma protein binding allow for excellent tissue penetration and concentrations, as reflected in their particularly large apparent volumes of distribution.Infections due to aerobic Gram-negative pathogens are considered those most susceptible to the quinolones. Disease indications in which these agents appear to offer the greatest therapeutic advantage over currently available alternatives include the following: complicated urinary tract infections (particularly those caused by Pseudomonas aeruginosa or resistant Gram-negative microorganisms); suspected bacterial gastroenteritis; eradication of Salmonella typhi from the faeces in known carriers; P. aeruginosa-associated respiratory exacerbation in patients with cystic fibrosis; and chronic Gram-negative bacterial osteomyelitis.Direct comparisons of the various quinolones are too limited to date to provide clear therapeutic options. Nevertheless, this class of compounds is likely to playa major role in providing effective oral therapy for conditions that have previously required prolonged parenteral treatment.

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Clinical role of the quinolones today and in the future

Cited by 11 publications

References 11 publications

Effects of ampicillin, ceftriaxone, chloramphenicol, pefloxacin and trimethoprim-sulphamethoxazole on Salmonella typhi within human monocyte-derived macrophages

Effects of ampicillin, ceftriaxone, chloramphenicol, pefloxacin and trimethoprim-sulphamethoxazole on Salmonella typhi within human monocyte-derived macrophages

Use of quinolones in pediatrics

The Quinolones

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