Efficacy Of Quinolones Research Articles

Clinical and Microbiological Efficacy of Adjunctive Systemic Quinolones to Mechanical Therapy in Periodontitis: A Systematic Review of the Literature

Objectives To assess the clinical and microbiological efficacy of systemic quinolones adjunctive to mechanical therapy in periodontitis patients. Materials and Methods. A systematic review of the scientific literature was carried out. The search scheme comprised the Scopus, PubMed/MEDLINE, SCIELO (Scientific Electronic Library Online), and LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud) databases, together with the gray literature. MeSH terms and keywords were utilized to explore publications in all idioms. Only randomized clinical trials (RCTs) that met the selection criteria were included. Results A total of 4 RCTs were selected. These RCTs found superior clinical and microbiological efficacy of adjunctive systemic moxifloxacin (MOX) and levofloxacin (LV) compared to subgingival debridement plus placebo. Improvements in PD and CAL were 2.4 ± 0.8 mm and 2.7 ± 0.9 mm for LV, and 1.5 ± 0.5 mm and 1.8 ± 0.5 mm for MOX, respectively. After six months of follow-up, adjunctive MOX reduced the presence of Aggregatibacter actinomycetemcomitans to imperceptible levels, while LV markedly reduced this microorganism. Some adverse events were reported in the LV group and none in the MOX group. Conclusions Adjunctive MOX and LV improve probing depth and clinical attachment level compared with subgingival debridement alone in patients with periodontitis. The efficacy of these quinolones against A. actinomycetemcomitans was also superior.

Efficacy of Quinolones against Secondary Pneumococcal Pneumonia after Influenza Virus Infection in Mice

We established a mouse model of secondary pneumococcal pneumonia after influenza virus infection and investigated the efficacy of several quinolones against pneumonia in this model. Gatifloxacin exhibited the highest efficacy among the quinolones examined and is probably useful for the treatment of secondary bacterial pneumonia.

Quinolones for Treatment of Nosocomial Pneumonia: A Meta-Analysis

Although quinolones are often used to treat nosocomial pneumonia (NP), there have been few trials documenting their efficacy in treating NP. Given the growing use of quinolones and issues regarding resistance, we conducted a meta-analysis of all trials of quinolones for treatment of NP. We identified 5 randomized trials comparing quinolones with other agents used to treat NP. The studies varied in both quality and sample size and included a total of nearly 1200 subjects. Four of the 5 trials used ciprofloxacin, administered every 8 h, whereas the fifth used levofloxacin administered daily. In 3 trials, the comparator agent was imipenem-cilistatin, whereas, in 2 trials, ceftazadime was the comparator agent. The efficacy of quinolones and comparator antibiotics was similar, with a pooled odds ratio for clinical cure of 1.12 (95% confidence interval, 0.80-1.55). Neither microbiological eradication rates nor mortality rates varied on the basis of antimicrobial selection.

Quinolones in gastrointestinal infections.

Fluoroquinolones are efficient antimicrobial drugs for the treatment of enteric fever, shigellosis, Escherichia coli diarrhea, cholera, and traveler's diarrhea. They also play a role in the therapy of yersiniosis, campylobacteriosis, and intestinal salmonellosis. A single dose of quinolones has been effective in the treatment of traveler's diarrhea and cholera. Uncomplicated typhoid fever was cured by norfloxacin, pefloxacin, and ofloxacin 400 mg twice daily (b.i.d.) for 7-14 days or ciprofloxacin 500 mg b.i.d. for 10 days. A single daily dose of 400 mg fleroxacin for 3 days has been shown to be effective in this indication. A few reports suggest that the newer quinolones can eliminate the carrier state. The efficacy of quinolones in the prophylaxis and treatment of intra-abdominal infections following abdominal surgery requires further investigation.

Efficacy of quinolones in preventing Staphylococcus aureus-induced abscess in mice.

The new fluoroquinolones clinafloxacin, CI-990 (PD 131112/PD 131628), sparfloxacin, and PD 138312 were bactericidal against Staphylococcus aureus with MICs > or = 4-fold lower than ciprofloxacin values. In a murine subcutaneous abscess model (subcutaneous/oral dosing) the new drugs displayed protective activities against five strains which were generally higher (up to 19-fold) than ciprofloxacin values.

QUINOLONE PROPHYLAXIS IN NEUTROPENIC PATIENTS - EFFICACY VERSUS RESISTANCE

To assess the efficacy of quinolones in the prophylaxis of infections in neutropenic patients with acute non-lymphocytic leukemia, and to evaluate the emergence of quinolone resistance in two University Hospitals in Brazil, we retrospectively compared 101 consecutive episodes of neutropenia managed with quinolone prophylaxis between 1989 and November 1993, and 26 previous episodes without prophylaxis, and reviewed the results of in vitro sensitivity of Gram-negative strains to quinolones in the same period. Prophylaxis with quinolones resulted in less episodes of bacteremias (21% vs. 69%, p=10(-7)), including Gram-negative bacteremias (6% vs. 38%, p=10(-5)), with no statistically significant difference in the death rate (18% vs. 31%, p=0.14, 95% confidence interval -6-32). The resistance of Gramnegative strains to quinolones rose from 7% to 18% between 1990 and 1993 (p=10(-5)). The resistance against ceftazidime and amikacin, the agents used in the empirical antibiotic therapy, increased in the same proportion as the quinolones. Given the limited benefit of quinolones as prophylaxis and the increasing number of quinolone-resistant Gram-negative strains observed in our hospitals, the use of quinolones as prophylaxis must be seriously questioned. A stricter control of the use of quinolones in these hospitals might decrease resistance.

Bacterial Killing and Reduction in Bacterial Virulence Contribute to the Efficacy of Quinolones

Bacterial Killing and Reduction in Bacterial Virulence Contribute to the Efficacy of Quinolones

Correlation between pharmacokinetics, pharmacodynamics and efficacy of antibacterial agents in animal models

On the basis of a review of published literature it is demonstrated that pharmacokinetic parameters of antibacterial agents correlate well with therapeutic efficacy in animal models, provided pharmacodynamic parameters are taken into account. The time that serum levels exceed the MIC is the most significant parameter determining efficacy of beta-lactams, whereas the efficacy of aminoglycosides is dependent on serum concentrations and the area under the curve. The efficacy of quinolones tends to be correlated to the doses administered or drug levels achieved. However, specific pharmacodynamic properties contribute significantly to the therapeutic efficacy of a few quinolones only whereas other quinolones lack these specific pharmacodynamic attributes. Thus, the correlation of pharmacokinetic parameters with therapeutic efficacy provides important basic concepts for the design of preclinical and clinical studies in the course of which additional pharmacodynamic properties will become apparent.

Use of fluoroquinolones for intracellular pathogens.

Current microbiologic techniques (determinations of minimal inhibitory and/or microbicidal concentrations) are unable to delineate the true role of anti-infectious drugs in the treatment of human infections due to intracellular pathogens. The prediction and evaluation of the efficacy of quinolones against intracellular pathogens requires information on four different steps. (1) Quinolones should be able to penetrate phagocytes; intramacrophagic concentration is highly dependent on serum pharmacokinetics; finally, the best quinolone should have the longest serum half-life and reach highest maximum serum concentrations. (2) The evaluation of antibacterial activity requires an adequate cellular model (e.g., multiplication of Legionella pneumophila within human monocyte-derived macrophages). (3) The prediction of drug efficacy requires an experimental animal model. (4) Clinical trials in human disease are necessary. This stage is difficult when the evaluation concerns severe infectious diseases because the rarity of these diseases makes random clinical trials difficult. In this paper we describe methodologies for assessing the efficacy of quinolones against intracellular bacterial pathogens with a particular focus on Legionella pneumophila.

Fluorinated quinolones. A review of their mode of action, antimicrobial activity, pharmacokinetics and clinical efficacy.

Quinolones, chemically related to nalidixic acid, have a strong and rapid bactericidal action against Gram-negative bacteria, including Ps. aeruginosa, some Mycobacteria, Legionella and Staphylococci. Streptococci and anaerobic bacteria are usually less sensitive. The quinolones exert their bactericidal action through inhibition of the enzyme DNA gyrase. Quinolones are absorbed for 50-100% from the gastro-intestinal tract, their volume of distribution is generally high (2 l/kg) and high concentrations are reached in almost all organs. The elimination half-lives range from 4 to 14 h. The efficacy of quinolones in urinary tract infections has been shown in many studies. They also seem to be effective in many serious infections. In animal studies their efficacy was generally equal or superior to aminoglycosides. Until now only mild and infrequent side effects have been reported.