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Since the introduction of ciprofloxacin in 1987, fluoroquinolones have expanded far beyond their early role in the treatment of urinary tract infections. Clinical applications beyond genitourinary tract infections include upper and lower respiratory infections, gastrointestinal infections, gynecologic infec tions, sexually transmitted diseases, and some skin and soft tissue infections. Their ease of administration, favorable pharmacokinetic properties, excellent tolerability, and efficacy give them enormous potential for use and misuse alike. Quinolones have few common adverse effects, most notably nausea, headache and dizziness. Less frequent but more serious adverse events include prolongation of the corrected QT interval, phototoxicity, liver enzyme abnor malities, arthropathy, and cartilage and tendon abnormalities. While possess ing many of the favorable properties of intravenous agents, most fluoro quinolones offer the convenience of oral administration, thus contributing to decreased health-care costs through increased outpatient therapy and short ened hospital stays. With the recent introduction of agents such as gatifloxacin and moxifloxacin, the traditional Gram-negative coverage of fluoroquinolones has been expanded to include Gram-positive organisms, most importantly Streptococcus pneumoniae.
The history of quinolones.- Structure-activity relationships of quinolones.- Epidemiology and mechanisms of resistance.- Improved safety profile of newer fluoroquinolones.- Pharmacokinetics and pharmacodynamics (PK/PD) of fluoro-quinolones: tools for combating bacteria and preventing resistance.- Fluoroquinolones in urinary tract infection.- The quinolones and sexually transmitted infections.- Gastrointestinal and intraabdominal infections.- The quinolones in otitis media and upper respiratory infections.- Quinolones in pneumonia.- Fluoroquinolones for the treatment of respiratory tractinfections other than pneumonia.- Quinolones for the treatment of skin, soft tissue, bone andprosthetic joint infections.- The role of fluoroquinolones in the therapy and prophylaxisof neutropenic patients with cancer.- Less usual indications: Mycobacterial, Brucella, Yersinia,Francisella and other infections.- The quinolones: future prospects.