Rational use of the fluoroquinolones

Richards, GA; Brink, Adrian; Feldman, Charles

doi:10.7196/samj.2019.v109i6.14002

Cited by 19 publications

(22 citation statements)

References 27 publications

(27 reference statements)

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“…Specifically, application of Clinical Laboratory and Standards Institute breakpoints in clinical practice has shown little activity of FQs 21 , 22 , and there is potentially mild antagonism between FQs and CAM in combination therapies 17 . Moreover, FQs have received warnings from the US Food and Drug Administration and the European Medicines Agency for significant adverse effects, including peripheral neuropathy, psychosis, hypoglycaemia, tendon rupture, and aortic dissection 23 . Recently, Khadawardi et al 24 reported that substitution of RFP or EB with FQs resulted in similar treatment outcomes compared with standard triple-drug regimens.…”

Section: Discussionmentioning

confidence: 99%

First line treatment selection modifies disease course and long-term clinical outcomes in Mycobacterium avium complex pulmonary disease

Fukushima

Kitada

Komukai

et al. 2021

Sci Rep

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The combination of rifamycin (RFP), ethambutol (EB), and macrolides is currently the standard regimen for treatment of Mycobacterium avium complex pulmonary disease (MAC-PD). However, poor adherence to the standardized regimens recommended by current guidelines have been reported. We undertook a single-centred retrospective cohort study to evaluate the long-term outcomes in 295 patients with MAC-PD following first line treatment with standard (RFP, EB, clarithromycin [CAM]) or alternative (EB and CAM with or without fluoroquinolones (FQs) or RFP, CAM, and FQs) regimens. In this cohort, 80.7% were treated with standard regimens and 19.3% were treated with alternative regimens. After heterogeneity was statistically corrected using propensity scores, outcomes were superior in patients treated with standard regimens. Furthermore, alternative regimens were significantly and independently associated with sputum non-conversion, treatment failure and emergence of CAM resistance. Multivariate cox regression analysis revealed that older age, male, old tuberculosis, diabetes mellitus, higher C-reactive protein, and cavity were positively associated with mortality, while higher body mass index and M. avium infection were negatively associated with mortality. These data suggest that, although different combination regimens are not associated with mortality, first line administration of a standard RFP + EB + macrolide regimen offers the best chance of preventing disease progression in MAC-PD patients.

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Section: Discussionmentioning

confidence: 99%

First line treatment selection modifies disease course and long-term clinical outcomes in Mycobacterium avium complex pulmonary disease

Fukushima

Kitada

Komukai

et al. 2021

Sci Rep

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“…There are some restrictions in place at present, like the prohibited prescription of ciprofloxacin for complicated UTIs, but controls must become more widespread to make a greater impact [198]. There have recently been restrictions placed on the use of FQs for mild bacterial infections, but this is due to potential side effects and not for antimicrobial resistance reasons [199]. Alongside this, the evidence that the misuse and sublethal exposure of FQs is potentially leading to an increase in mutagenesis and resistance to other antibiotics is of concern.…”

Section: Future Prospectsmentioning

confidence: 99%

Quinolones: Mechanism, Lethality and Their Contributions to Antibiotic Resistance

et al. 2020

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Fluoroquinolones (FQs) are arguably among the most successful antibiotics of recent times. They have enjoyed over 30 years of clinical usage and become essential tools in the armoury of clinical treatments. FQs target the bacterial enzymes DNA gyrase and DNA topoisomerase IV, where they stabilise a covalent enzyme-DNA complex in which the DNA is cleaved in both strands. This leads to cell death and turns out to be a very effective way of killing bacteria. However, resistance to FQs is increasingly problematic, and alternative compounds are urgently needed. Here, we review the mechanisms of action of FQs and discuss the potential pathways leading to cell death. We also discuss quinolone resistance and how quinolone treatment can lead to resistance to non-quinolone antibiotics.

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“…The systemic fluoroquinolones (FQs) have been used for >30 years for a variety of infectious conditions, and have been among the most wide ly prescribed antibiotics globally (Richards et al, 2019).…”

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confidence: 99%

Histopathological Effects of using Grape Seed Extract Alone or in Combination with Ofloxacin against Pasteurella Multocida in Rabbits

El-Sheikh¹,

Galal²,

Youssef³

et al. 2020

Adv. Anim. Vet. Sci.

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R abbits are viewed as one of the essential domesticated animals that give high quality protein sustenance. One of the most important health problems in rabbit is pasteurellosis, which is considered as a common bacterial disease caused by Pasteurella multocida (P. multocida) and has been reported as a constant serious and highly contagious disease of domestic rabbits (Nassar et al., 2013). Rabbit pasteurellosis causes symptoms that range from fatal septicemia, severe pleuritis, and pneumonia to less severe sequelae such as multiple abscesses, chronic rhinitis, and otitis media. It mostly affects rabbits at 4-8 weeks of age causing manifestations going from lethal septicemia, serious pleuritis, and pneumonia to less extreme sequelae, for example, various abscesses, perpetual rhinitis, and otitis media. The result of any type of the ailment is extreme financial misfortunes. Rabbits older than 8months to 1 year of age showed lower incidence (Mohamed et al., 2019). Pasteurellosis exhibited 3 forms in rabbits. The first one is snuffles or nasal catarrhal inflammation which is characterized by acute, subacute, and chronic inflammation of the air passages and lungs. This form of the disease often ends with death and the cured animals became carriers. The second form is characterized by abscess formation at any part of the body and the case is terminated with septicemia. The last form is characterized by genital infection, which manifests as acute and subacute inflammation of uterus

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Rational use of the fluoroquinolones

Abstract: This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Cited by 19 publications

References 27 publications

First line treatment selection modifies disease course and long-term clinical outcomes in Mycobacterium avium complex pulmonary disease

First line treatment selection modifies disease course and long-term clinical outcomes in Mycobacterium avium complex pulmonary disease

Quinolones: Mechanism, Lethality and Their Contributions to Antibiotic Resistance

Histopathological Effects of using Grape Seed Extract Alone or in Combination with Ofloxacin against Pasteurella Multocida in Rabbits

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