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A Review of New Fluoroquinolones

Focus on their Use in Respiratory Tract Infections

  • Review Article
  • Published:
Treatments in Respiratory Medicine

Abstract

The new respiratory fluoroquinolones (gatifloxacin, gemifloxacin, levofloxacin, moxifloxacin, and on the horizon, garenoxacin) offer many improved qualities over older agents such as ciprofloxacin. These include retaining excellent activity against Gram-negative bacilli, with improved Gram-positive activity (including Streptococcus pneumoniae and Staphylococcus aureus). In addition, gatifloxacin, moxifloxacin and garenoxacin all demonstrate increased anaerobic activity (including activity against Bacteroides fragilis). The new fluoroquinolones possess greater bioavailability and longer serum half-lives compared with ciprofloxacin. The new fluoroquinolones allow for once-daily administration, which may improve patient adherence. The high bioavailability allows for rapid step down from intravenous administration to oral therapy, minimizing unnecessary hospitalization, which may decrease costs and improve quality of life of patients. Clinical trials involving the treatment of community-acquired respiratory infections (acute exacerbations of chronic bronchitis, acute sinusitis, and community-acquired pneumonia) demonstrate high bacterial eradication rates and clinical cure rates. In the treatment of community-acquired respiratory tract infections, the various new fluoroquinolones appear to be comparable to each other, but may be more effective than macrolide or cephalosporin-based regimens. However, additional data are required before it can be emphatically stated that the new fluoroquinolones as a class are responsible for better outcomes than comparators in community-acquired respiratory infections. Gemifloxacin (except for higher rates of hypersensitivity), levofloxacin, and moxifloxacin have relatively mild adverse effects that are more or less comparable to ciprofloxacin. In our opinion, gatifloxacin should not be used, due to glucose alterations which may be serious. Although all new fluoroquinolones react with metal ion-containing drugs (antacids), other drug interactions are relatively mild compared with ciprofloxacin. The new fluoroquinolones gatifloxacin, gemifloxacin, levofloxacin, and moxifloxacin have much to offer in terms of bacterial eradication, including activity against resistant respiratory pathogens such as penicillin-resistant, macrolide-resistant, and multidrug-resistant S. pneumoniae. However, ciprofloxacin-resistant organisms, including ciprofloxacin-resistant S. pneumoniae, are becoming more prevalent, thus prudent use must be exercised when prescribing these valuable agents.

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Notes

  1. 1 The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgments

Drs Zhanel, Noreddin, Rubinstein, and Hoban have received research grants from companies making ciprofloxacin, garenoxacin, gatifloxacin, gemifloxacin, levofloxacin, and moxifloxacin. No sources of funding were used to assist in the preparation of this review.

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Authors and Affiliations

  1. Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

    George G. Zhanel, Sonya Fontaine, Heather Adam, Kristen Schurek, Matt Mayer, Alfred S. Gin, Ethan Rubinstein & Daryl J. Hoban

  2. Department of Clinical Microbiology, Health Sciences Centre, MS673 - 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9, Canada

    George G. Zhanel & Daryl J. Hoban

  3. Department of Medicine, Health Sciences Centre, Winnipeg, Manitoba, Canada

    George G. Zhanel & Ethan Rubinstein

  4. Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, Minnesota, USA

    Ayman M. Noreddin

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  1. George G. Zhanel
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Correspondence to George G. Zhanel.

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Zhanel, G.G., Fontaine, S., Adam, H. et al. A Review of New Fluoroquinolones. Treat Respir Med 5, 437–465 (2006). https://doi.org/10.2165/00151829-200605060-00009

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