Use of quinolones in the treatment of gastrointestinal infections

Abstract

Bacterial enteropathogens are responsible for between 40% and 80% of diarrheal illness depending upon the age of the persons affected and geographic areas where illness occurs. Antibacterial agents will shorten the illness associated with enteric infection caused by enterotoxigenic Escherichia coli, Shigella spp. and Campylobacter jejuni. These drugs also are effective in the therapy of certain clinical conditions (presumably because they are due to the same agents) which are characterized by moderate to severe diarrhea with one or more of the following: high fever, dysentery (passage of bloody mucoid stools), or high leukocyte counts in stools. Antimicrobial agents are also effective in the therapy of travelers' diarrhea. The quinolone drugs have several advantages in the management of bacterial diarrhea where strains causing illness from nearly all regions of the world will show general susceptibility: high concentrations are achieved in the intestinal lumen following oral administration and resistance development is unusual. A quinolone probably represents the optimal agent for therapy of bacterial diarrhea in adults in areas where trimethoprim-resistant enteric pathogens are common.

Quinolone resistance and Campylobacter

“…Fluoroquinolone‐resistant Campylobacter strains arising after treatment for enteritis were first observed in the late 1980s, and several international reports document up to 20% of patients relapsing because of the emergence of a resistant isolate only inhibited by 32 mg/L ciprofloxacin or more [11,23–28]. Failure of ciprofloxacin therapy of campylobacter infection in an AIDS patient has been reported [28,29].…”

“…Clinical trials with fluoroquinolones have demonstrated a good response, and it was further suggested, and reiterated recently, that fluoroquinolones would be useful for the prophylaxis of travelers’ diarrhea, as these agents gave symptomatic relief and shortened the duration of illness [10]. However, there is clear evidence that microbiological eradication is no quicker in the presence of fluoroquinolone therapy [11]. Resistance of Campylobacter strains to fluoroquinolone antimicrobials has been recognized for several years, and emergence of resistance after fluoroquinolone therapy in humans has also been reported [12].…”

Resistance in faecal Escherichia coli isolated from pigfarmers and abattoir workers

“…Many studies have examined the resistance of enteric bacteria in humans after antibiotic therapy [4][5][6][7][8], but there is much less information available on the prevalence of antibiotic resistance in the faecal flora of healthy adults who have not used antibiotics recently [9][10][11][12][13]. However, such subjects are potential recipients of antimicrobial agents.…”

High level resistance to trimethoprim, cotrimoxazole and other antimicrobial agents among clinical isolates of Shigella species in Ontario, Canada – an update

“…Recently however, resistance to nalidixic acid has appeared in some areas [20,21 ] hence close monitoring of Ontario strains is necessary to detect resistant isolates when they arise. The newer quinolones, ciprofloxacin and norfloxacin, have enhanced in vitro activity against Shigella species [18,22,23] and have been suggested as an alternative therapeutic option, but these drugs are costly and have not been approved for use in children due to their potential toxicity for developing joints [15]. The aminoglycosides, gentamicin, tobramycin and amikacin, were also effective against the strains in this study, resistance of shigellae to some aminoglycosides have been reported [2,6] but a number of in vitro studies have shown shigella to be susceptible to these agents [9,15,20].…”