Brush Letter Pharm: Fluoroquinolones
Happy Wednesday morning! I've been practicing these next few antibiotics all week, and if you're in the healthcare field you'll know that fluoroquinolones (FQs) are a hot topic of discussion lately. Why?
- Resistance against them is progressing
- In 2016, the FDA updated the labeling warning on FQs, discouraging their use for non-severe infections due to some of the serious side effects associated with them
- A new fluoroquinolone was just approved this past June! Baxdela (or delafloxacin) has activity against MRSA and pseudomonas, two bugs that cause us a lot of stress in the healthcare world
With those first two negatives, you'd think we may not see these all too often right? Wrong! While there are some cons associated with this class, they're extremely useful in community-acquired pneumonia (except Cipro!), uncomplicated urinary tract infections and intra-abdominal infections. Here's my brief overview of these three fluoroquinolones:
Mechanism of action: DNA Gyrase (Top II) inhibitors that inhibit the supercoiling, replication and separation of bacterial DNA. In normal people terms: the bacteria die.
Spectrum of coverage: This differs for each drug in this class
- Ciprofloxacin: gram negatives, atypicals, pseudomonas
- Levofloxacin: gram negatives, atypicals, pseudomonas, strep pneumo
- Moxifloxacin: gram negatives, atypicals, strep pneumo, anaerobes
Important take aways? Cipro/Levo are your pseudomonas drugs, good for potential hospital acquired infections (nosocomial). And in the words of the infectious disease pharmacist who taught us ID (hey Dr.Shah!): Don't use Cipro for pneumonia, ever, unless you want to get sued for malpractice (it doesn't cover strep pneumo)
ADR: tendon rupture, bone/cartilage formation abnormalities, N/V/D, C.diff infection, QTc prolongation (mostly Moxi), photosensitivity
Fun facts:
- These drugs cannot be taken with milk, iron, magnesium, calcium, antacids (Tums), they must be separated by either taking the antibiotic 4 hours before, or 8 hours after these other drugs.
- The first quinolone was nalidixic acid, isolated in 1963
- There are currently four generations of FQs
- Ciprofloxacin is a CYP3A4 inhibitor
Hope you enjoyed this edition of brush letter pharm! More to come soon! (Especially now that I got new Tombow pens, thank you Amazon Prime!)
0 comments