Fluoroquinolones Antibiotics Overview
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Questions and Answers

What is the key difference between the older and newer groups of fluoroquinolones?

  • Different mechanism of action
  • Different spectrum of activity (correct)
  • Different year of introduction
  • Different chemical structure

    • Why are trovafloxacin and gatifloxacin no longer on the market?

  • Due to allergic reactions
  • Due to liver toxicity and hypoglycemia/hyperglycemia, respectively (correct)
  • Due to resistance development
  • Due to high cost

    • Why are the newer fluoroquinolones referred to as respiratory fluoroquinolones?

  • Due to limited treatment indications
  • Due to their activity against S.pneumoniae (correct)
  • Due to lack of adverse effects
  • Due to specific drug distribution

    • What is the primary way in which fluoroquinolones exert their bactericidal effects?

    <p>Interference with enzymes required for bacterial DNA synthesis and repair</p> Signup and view all the answers

    Why is sparfloxacin no longer available in the United States?

    <p>Due to withdrawal from the market</p> Signup and view all the answers

    What distinguishes fluoroquinolones from the older quinolone nalidixic acid in terms of antimicrobial efficacy?

    <p>$2$ chemical moieties added to the structure</p> Signup and view all the answers

    What is responsible for the antipseudomonal activity of fluoroquinolones?

    <p>Piperazine moiety</p> Signup and view all the answers

    Which enzyme do fluoroquinolones inhibit to prevent the relaxation of positively supercoiled DNA?

    <p>DNA gyrase</p> Signup and view all the answers

    What is the best predictor for clinical efficacy of fluoroquinolones?

    <p>Ratio of exposure to the drug (AUC) to minimum inhibitory concentration (MIC)</p> Signup and view all the answers

    Which fluoroquinolone has significant activity against anaerobic organisms?

    <p>Moxifloxacin</p> Signup and view all the answers

    What has eroded the utility of fluoroquinolones according to the text?

    <p>Overuse</p> Signup and view all the answers

    Which enzyme is mutated in organisms that develop resistance to fluoroquinolones?

    <p>DNA gyrase</p> Signup and view all the answers

    Why does the CDC no longer recommend fluoroquinolones for gonorrhea treatment?

    <p>Resistance development</p> Signup and view all the answers

    What is the main factor associated with clinical failures and resistance development in bacteria?

    <p>$AUC:MIC$ less than 125 for gram-negative bacteria and less than 30 for gram-positive bacteria</p> Signup and view all the answers

    Which population group is at high risk of developing tendon rupture when taking fluoroquinolones?

    <p>Older adults</p> Signup and view all the answers

    What is the primary reason why lactating women should use fluoroquinolones sparingly?

    <p>To decrease the risk of tendon rupture</p> Signup and view all the answers

    Which fluoroquinolone is detected in breast milk but ingested in small doses by infants?

    <p>Ciprofloxacin</p> Signup and view all the answers

    What is the recommended use of fluoroquinolones in patients younger than 18 years according to the FDA?

    <p>For complicated UTIs and pyelonephritis</p> Signup and view all the answers

    Which adverse drug reaction has been reported with nearly all antibacterial agents, including fluoroquinolones?

    <p>Clostridioides difficile infection (CDI)</p> Signup and view all the answers

    What common GI adverse reactions are associated with fluoroquinolones?

    <p>Abdominal pain and altered taste</p> Signup and view all the answers

    What symptomatology characterizes fluoroquinolone tendinitis?

    <p>Painful and swollen tendons leading to rupture</p> Signup and view all the answers

    What is the main recommendation by the AAP regarding the systemic use of fluoroquinolones in children?

    <p>Use as a last resort against MDR bacteria</p> Signup and view all the answers

    What health issue has been associated with prolonged or repeated therapy of fluoroquinolones?

    <p>Bacterial or fungal overgrowth of nonsusceptible organisms</p> Signup and view all the answers

    Which fluoroquinolones are known to penetrate the placenta?

    <p>Ciprofloxacin and ofloxacin</p> Signup and view all the answers

    Which fluoroquinolone is known to have minimal metabolism and predominant renal excretion?

    <p>Levofloxacin</p> Signup and view all the answers

    What side effect is specifically mentioned as a concern for patients with myasthenia gravis taking fluoroquinolones?

    <p>Tendon rupture</p> Signup and view all the answers

    Why are dosage adjustments necessary for most fluoroquinolones in patients with CrCl of 50 mL/min or less?

    <p>Due to renal impairment</p> Signup and view all the answers

    Which warning was published by the FDA regarding fluoroquinolone antibiotic use in 2018?

    <p>Aortic dissection or aneurysm occurrence</p> Signup and view all the answers

    What is the predominant route of elimination for nalidixic acid and moxifloxacin?

    <p>Metabolism</p> Signup and view all the answers

    What precautions should patients on fluoroquinolones take to prevent adverse reactions related to photosensitivity?

    <p>Avoid direct sunlight, sun lamps, and tanning beds during therapy and several days after completion.</p> Signup and view all the answers

    What action should patients take if they experience tenderness or inflammation in any tendon while on a fluoroquinolone?

    <p>Discontinue the fluoroquinolone, notify the prescriber, rest, and refrain from exercising the affected joint.</p> Signup and view all the answers

    What is the recommended daily fluid intake to prevent crystalluria while on fluoroquinolones?

    <p>$1,500$ mL per day</p> Signup and view all the answers

    When should diabetic patients report any signs or symptoms of hypoglycemia while on fluoroquinolones?

    <p>Immediately</p> Signup and view all the answers

    What should patients do at any sign of an allergic reaction (hives, itching, dyspnea) while on a fluoroquinolone?

    <p>Discontinue the drug immediately.</p> Signup and view all the answers

    What is the recommended action for patients experiencing dizziness or lightheadedness while on fluoroquinolones?

    <p>Avoid driving and hazardous activities until the patient's reaction is known.</p> Signup and view all the answers

    What is a significant implication to consider when selecting fluoroquinolones?

    <p>Cost</p> Signup and view all the answers

    Which fluoroquinolone may be a cost-effective choice due to being on multiple $4 or reduced cost generic lists?

    <p>Ciprofloxacin</p> Signup and view all the answers

    What is a reason to use fluoroquinolones judiciously?

    <p>To prevent resistance</p> Signup and view all the answers

    Which fluoroquinolone is unique as an oral agent effective for P. aeruginosa?

    <p>Ciprofloxacin</p> Signup and view all the answers

    Which fluoroquinolone achieves a much higher AUC:MIC ratio than levofloxacin and ciprofloxacin?

    <p>Gemifloxacin</p> Signup and view all the answers

    What should be monitored for patients on prolonged therapy with fluoroquinolones?

    <p>Organ function, including renal, hepatic, and hematopoietic function</p> Signup and view all the answers

    What effect can dehydration lead to in patients taking fluoroquinolones?

    <p>Crystalluria</p> Signup and view all the answers

    Why should fluoroquinolones not be taken within 2 to 6 hours of certain drugs?

    <p>To prevent absorption issues due to chelation</p> Signup and view all the answers

    Which group should avoid using fluoroquinolones unless there are compelling reasons?

    <p>Children and pregnant women</p> Signup and view all the answers

    What should patients understand about taking antimicrobial drugs like fluoroquinolones?

    <p>All doses must be taken and the full course must be completed.</p> Signup and view all the answers

    What is a black box warning associated with the use of fluoroquinolones?

    <p>Risk of tendonitis and tendon rupture</p> Signup and view all the answers

    Which enzyme is inhibited by ciprofloxacin, leading to increased drug levels of caffeine, zolpidem, and other drugs?

    <p>CYP1A2</p> Signup and view all the answers

    Why should dairy products not be consumed concurrently with ciprofloxacin?

    <p>They decrease the drug's absorption</p> Signup and view all the answers

    Which fluoroquinolone is specifically mentioned as increasing cyclosporine's nephrotoxic effects?

    <p>Norfloxacin</p> Signup and view all the answers

    Why are fluoroquinolones no longer recommended as first-line treatment for simple UTIs?

    <p>Due to antibiotic resistance issues</p> Signup and view all the answers

    In which condition are fluoroquinolones considered first-line therapy for treatment?

    <p>Community-acquired pneumonia</p> Signup and view all the answers

    What is the recommended self-treatment for traveler’s diarrhea involving fluoroquinolones?

    <p>$500 mg of oral ciprofloxacin combined with loperamide</p> Signup and view all the answers

    Why does the FDA recommend against using fluoroquinolones for acute bacterial sinusitis?

    <p>Owing to a high incidence of serious adverse reactions</p> Signup and view all the answers

    'Ciprofloxacin should not be used as chemoprophylaxis in pregnant women or children younger than age 18 years' - Why?

    <p>'safer options of ceftriaxone or azithromycin available'</p> Signup and view all the answers

    'Ciprofloxacin may be used off-label as a single 500 mg dose as chemoprophylaxis for high-risk adult contacts' - What should be considered before using ciprofloxacin for this purpose?

    <p>'confirmed susceptibility on culture and sensitivity'</p> Signup and view all the answers

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