Quinolone antibacterial agents for the treatment of genitourinary tract infections

Abstract

The fluoroquinolones have expanded the therapeutic options available for the treatment of genitourinary tract infections. Their ease of oral administration, favourable pharmacokinetics, low incidence of adverse reactions, and broad spectrum of in vitro activity against aerobic and facultative organisms make them especially suitable for treating bacteriuria, particularly when pathogens are resistant to other available oral agents. Their efficacy has also been established in the treatment of prostatis, gonorrhea and chancroid. They have lower in vitro activity against chlamydia, ureaplasma and anaerobes, and their role in the treatment of non-gonococcal urethritis, vaginitis and acute pelvic inflammatory disease is less well established.

Clinical role of the quinolones today and in the future

“…These include the very low MIC of all quinolones against most gram-negative rods, the ease of their administration, the rare emergence of bacterial resistance of the chromosomal type associated with quinolone use, the absence of plasmid transfer with its devastating epidemiological consequences, and the high rate of recovery of the quinolones in urine, ranging from 28% for norfloxacin to 73% for ofloxacin (9). Indeed, the high rate of recovery in urine implies that even "resistanf' organisms such as Staphylococcus epidermiclis and Enterococcus faecalis may be partially eradicated in uncomplicated urinary tract infections.…”

“…The emergence of either intrinsically resistant or penicillinase-producing Neisseria gonorrheae throughout the world, as well as the recognition of their frequent association with other organisms producing urethritis or an asymptomatic carrier state, has challenged standard therapeutic practices and stimulated the development of new chemotherapeutic strategies (9). Ideally, in the future the recognition of urethritis should lead to the administration of a single agent in one dose, eradicating all three potential organisms: Neisseria gonorrheae (whether penicillinaseproducing or not), Chlamydia trachomatis and Ureaplasma spp.…”