Introduction

Abstract

During the last two decades, the use of fluoroquinolones has increased enormously in practically all the institutions of the developed world. The use of this group of drugs is even greater outside hospitals where they are one of the more commonly prescribed agents for community-acquired infections. The present supplement to Clinical Microbiology and Infection reviews the more common indications for clinical use of fluoroquinolones, their immediate challenges and prospects for the future. Modern fluoroquinolones are among the most commonly selected group of agents for the therapy of community-acquired pneumonia. The article by Carratalá et al. reviews the role of fluoroquinolones in CAP, highlighting the wide spectrum of activity of these drugs against many respiratory tract pathogens, including Streptococcus pneumoniae and other microorganisms of the so called atypical pneumonia group. Fluoroquinolones are active against the overwhelming majority of isolates of S. pneumoniae including strains resistant to penicillin and other multiresistant strains as discussed in the article by File et al. Cunha reviews the present role of atypical microorganisms as etiologic agents of pneumonia, in different age groups while Yu et al. compare the potential value of fluoroquinolones and macrolides in the treatment of legionnaire's disease. Quinolones are probably the agents of choice, at present, for the treatment of infections caused by microorganisms belonging to the genus Legionella, as the experience in recent outbreaks suggests. Mensa and Trilla review in their article the indications for antimicrobial therapy in patients with acute exacerbation of chronic bronchitis and the evidence in favour of the use of fluoroquinolones in some of those patients. The issues regarding the relationship between the use and misuse of fluoroquinolones and the development of resistance to S. pneumoniae are discussed in depth by García-Rey et al. Use of fluoroquinolones in nonrespiratory infections also deserves a considerable amount of space in this issue. Wagenlehner and Naber discuss the difficult issue of bacterial prostatitis and with their extensive experience they provide an interesting insight into the appropriate use of fluoroquinolones in prostatitis. Another very interesting topic is the use of fluoroquinolones in patients with osteoarticular infections and this is reviewed by Barberán et al. Fluorquinolones are, at present, among the more commonly used drugs for the treatment of bone and joint infections. This is due to their spectrum of in-vitro activity, bone penetration and convenience of use for the patients. The oral bioavailability of the drug and good tolerance allow for very prolonged periods of oral and home-based therapy. Finally, levofloxacin is establishing a niche as an agent of potential use in selected cases of patients with severe pneumonia admitted to Intensive Care Units which includes certain patients with ventilator-associated pneumonia. This context is elegantly reviewed by Alvarez-Lerma et al. This issue reflects the opinions of different authors from both the USA and Europe to whom I am grateful for their contributions. I sincerely hope that the readers of CMI enjoy the information and find it attractive and stimulating.