Pharmacist Development<br />Group<br />
Scientific Department<br />Easy microbiology programme<br />Present<br />
antibiotics course1-Quinolones<br />By<br />Dr.MohamedNassar<br />
The Lecture In Points<br />
Quinolones general information<br />Visit video department on<br />pharmacist development website<br />
Quinolones and fluoroquinolones<br /><ul><li>Quinolones include nalidixicacid the old member of quinolones and the fluroqu...
The older drug, nalidixic acid, is a nonfluorinatedquinolone, and is not effective against systemic infections. Its use in...
The fluoroquinolones in the Egyptian market are collected in the following slide .</li></li></ul><li>
Other quinolones<br /><ul><li>There are other types of fluroquinolones not available in Egypt include Enoxacin , pefloxaci...
Fluoroquinolones action , side actions & interactions<br />Refresh your information by medical reminder on pharmacist deve...
Mechanism of action<br /><ul><li>Quinolones inhibit bacterial DNAgyrase(important for coiling DNA) and topoisomerase (requ...
200–400 mg every 12 hours for ofloxacin .
400 mg every 12 hours for norfloxacin and pefloxacin .
250–750mg every 12 hours for ciprofloxacin.
500-750 mg once daily for levofloxacin .</li></li></ul><li>Main side effects<br /><ul><li>Nausea and anorexia.
Allergicreactions(most common with gemifloxacin; less common with other quinolones).
Arthropathy and tendonitis. May damage cartilage. Not routinely recommended in children.
Gatifloxacin can cause hypo- or hyperglycemia.
Moxifloxacin prolongs the QT interval.
Nephrotoxicity: Crystalluria has been reported in patients receiving excessive doses (3-4 times normal).
Phototoxicity: Patients are advised to avoid excessive sunlight.</li></li></ul><li>Interactions with quinolones<br /><ul><...
Sucralfate:- Reduced gastrointestinal absorption of ciprofloxacin, norfloxacin, and probably other quinolones.
warfarin, cyclosporine and caffeine :- Ciprofloxacin, ofloxacin and enoxacin increase thier serum levels .
Theophylline:- Ciprofloxacin , enoxacin, and, to a lesser extent, norfloxacin inhibit theophylline metabolism; levofloxaci...
patients with CNS disorders, such as epilepsy, should be treated cautiously with these drugs.</li></li></ul><li>Fluroquino...
Ciprofloxacin<br /><ul><li> Ciprofloxacin has an excellent gram-negativespectrum .
 Ciprofloxacin is the most potent quinolone for P. aeruginosa.
 Ciprofloxacin is one of the primary antibiotics recommended for treatment of urinary tract infections.
 It concentrates in the prostate and is recommended for treatment of prostatitis.
 For gonococcalurethritis, it is a useful alternative to ceftriaxone.
 Ciprofloxacin is effective against many systemic infections with the exception of serious infections caused by methicilli...
 Ciprofloxacin has been used effectively for traveler’s diarrhea most commonly caused by enterotoxigenicE. coli and Shigella.
 It is the drug of choice for Salmonella typhi (typhoid fever),
 Ciprofloxacin is an alternative to more toxic drugs, such as the aminoglycosides . It may act synergistically with B-Iact...
 Serious toxicities include phototoxicity (particularly with sparfloxacin), and prolongation of the QTc interval (seen wit...
Uses of fluoroquinolones<br /><ul><li>Urinary Tract Infections & Prostatitis
 The fluoroquinolones are more efficacious than trimethoprim–sulfamethoxazole for the treatment of urinary tract infection...
 A single oral dose of a fluoroquinolone such as ofloxacin or ciprofloxacin is effective treatment for sensitive strains o...
Bone, Joint, and Soft Tissue Infections
 the fluoroquinolones in combination with an agent with antianaerobic activity are a reasonable choice for diabetic foot i...
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Antibiotics course. 1-Quinolones

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The lectures in points :-
1- quinolones general information.
2-Fluoroquinolones action , side actions & interactions .
3-Fluroquinolones group members in detail .
4-Fluroquinolones in the clinical use .
5-Practical tips .
6-Rapid review .
7- Test yourself .

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Antibiotics course. 1-Quinolones

  1. 1. Pharmacist Development<br />Group<br />
  2. 2. Scientific Department<br />Easy microbiology programme<br />Present<br />
  3. 3. antibiotics course1-Quinolones<br />By<br />Dr.MohamedNassar<br />
  4. 4. The Lecture In Points<br />
  5. 5. Quinolones general information<br />Visit video department on<br />pharmacist development website<br />
  6. 6. Quinolones and fluoroquinolones<br /><ul><li>Quinolones include nalidixicacid the old member of quinolones and the fluroquinolones.
  7. 7. The older drug, nalidixic acid, is a nonfluorinatedquinolone, and is not effective against systemic infections. Its use in the treatment of urinary tract infections (UTIs) is limited due to the rapid emergence of resistant strains.
  8. 8. The fluoroquinolones in the Egyptian market are collected in the following slide .</li></li></ul><li>
  9. 9. Other quinolones<br /><ul><li>There are other types of fluroquinolones not available in Egypt include Enoxacin , pefloxacin , clinafloxacin , grepafloxacin and trovaflaxacin .</li></li></ul><li>Basic structure of the quinolones<br />
  10. 10. Fluoroquinolones action , side actions & interactions<br />Refresh your information by medical reminder on pharmacist development website mean page<br />
  11. 11. Mechanism of action<br /><ul><li>Quinolones inhibit bacterial DNAgyrase(important for coiling DNA) and topoisomerase (required to segregate DNA to daughter cells). Rapidly cidal , with concentration-dependent killing.</li></li></ul><li>Spectrum of fluroquinolones<br /><ul><li>All of the fluoroquinolones are bactericidal. In general, they are effective against gram-negative organisms such as the enterobacteria, pseudomonasorganisms, Haemophilusinfluenzae, Moraxellacatarrhalis, Legionella, Chlamydia and mycobacteria except for M- aviumintracellulare complex. They are effective in the treatment of gonorrhea but not syphilis. Though active against some gram-positive organisms, they should be avoided in the treatment of pneumoccal or enterococcal infections. Their activity against anaerobes is poor. If used prophylacticallybefore transurethral surgery, they lower the incidence of postsurgical UTIs.</li></li></ul><li>Quinolones dosage<br /><ul><li>Oral doses in adults are
  12. 12. 200–400 mg every 12 hours for ofloxacin .
  13. 13. 400 mg every 12 hours for norfloxacin and pefloxacin .
  14. 14. 250–750mg every 12 hours for ciprofloxacin.
  15. 15. 500-750 mg once daily for levofloxacin .</li></li></ul><li>Main side effects<br /><ul><li>Nausea and anorexia.
  16. 16. Allergicreactions(most common with gemifloxacin; less common with other quinolones).
  17. 17. Arthropathy and tendonitis. May damage cartilage. Not routinely recommended in children.
  18. 18. Gatifloxacin can cause hypo- or hyperglycemia.
  19. 19. Moxifloxacin prolongs the QT interval.
  20. 20. Nephrotoxicity: Crystalluria has been reported in patients receiving excessive doses (3-4 times normal).
  21. 21. Phototoxicity: Patients are advised to avoid excessive sunlight.</li></li></ul><li>Interactions with quinolones<br /><ul><li>Antiacids & minerals :- Decrease gastrointestinal absorption of ciprofloxacin, norfloxacin, enoxacin (and probably other quinolones).{ quinolones interact with compounds containing multivalent cations (Mg ++, AI +++, Ca++ ,Fe ++ ,Zn++).}.
  22. 22. Sucralfate:- Reduced gastrointestinal absorption of ciprofloxacin, norfloxacin, and probably other quinolones.
  23. 23. warfarin, cyclosporine and caffeine :- Ciprofloxacin, ofloxacin and enoxacin increase thier serum levels .
  24. 24. Theophylline:- Ciprofloxacin , enoxacin, and, to a lesser extent, norfloxacin inhibit theophylline metabolism; levofloxacin, lomefloxacin, ofloxacin, and sparfloxacin appear to have little effect.</li></li></ul><li>Contraindications<br /><ul><li>Fluoroquinolones should be avoided in pregnancy, in nursing mothers and in children under 18 yearsof age, since articular cartilage erosion (arthropathy) occurs in immature experimental animals.
  25. 25. patients with CNS disorders, such as epilepsy, should be treated cautiously with these drugs.</li></li></ul><li>Fluroquinolones group members in detail<br />Pharmadevelop<br />Channel<br />Medical videos all over the day <br />Learn & enjoy<br />
  26. 26. Ciprofloxacin<br /><ul><li> Ciprofloxacin has an excellent gram-negativespectrum .
  27. 27. Ciprofloxacin is the most potent quinolone for P. aeruginosa.
  28. 28. Ciprofloxacin is one of the primary antibiotics recommended for treatment of urinary tract infections.
  29. 29. It concentrates in the prostate and is recommended for treatment of prostatitis.
  30. 30. For gonococcalurethritis, it is a useful alternative to ceftriaxone.
  31. 31. Ciprofloxacin is effective against many systemic infections with the exception of serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA), the enterococci and pneumococci.
  32. 32. Ciprofloxacin has been used effectively for traveler’s diarrhea most commonly caused by enterotoxigenicE. coli and Shigella.
  33. 33. It is the drug of choice for Salmonella typhi (typhoid fever),
  34. 34. Ciprofloxacin is an alternative to more toxic drugs, such as the aminoglycosides . It may act synergistically with B-Iactams .</li></li></ul><li>Norfloxacin<br /><ul><li> This agent is effective against both gram-negative (including Pseudomonas aeruginosa) and gram-positive organisms in treating complicated and uncomplicated UTIs and prostatitis, but not in systemic infections. </li></li></ul><li>Ofloxacin<br /><ul><li> Like norfloxacin, ofloxacin is primarily used in the treatment of prostatitis due to E. coli and of sexually transmitted diseases (STDs) with the exception of syphilis. It may be used as alternative therapy in patients with gonorrhea. It has some benefit in the treatment of skin and lower respiratory tract infections. </li></li></ul><li>Lomefloxacin and enoxacin<br /><ul><li>Lomefloxacin and enoxacin are useful in the treatment of UTIs and bronchitis caused by Haemophilusinfluenzae or Moraxellacatarrhalis. Lomefloxacin is not effective against pseudomonalbacteremia. </li></li></ul><li>New fluoroquinolones<br /><ul><li> Compared with ciprofloxacin, new compounds show increased activity against gram-positive organisms, Gatifloxacin, clinafloxacin, trovafloxacin and moxifloxacin show increased activity against anaerobes, compared with ciprofloxacin.
  35. 35. Serious toxicities include phototoxicity (particularly with sparfloxacin), and prolongation of the QTc interval (seen with sparfloxacin and grepafloxacin). </li></li></ul><li>Fluroquinolones in the clinical use<br />Subscribe to pharmacist development newsletter and get valuable emails for free<br />
  36. 36. Uses of fluoroquinolones<br /><ul><li>Urinary Tract Infections & Prostatitis
  37. 37. The fluoroquinolones are more efficacious than trimethoprim–sulfamethoxazole for the treatment of urinary tract infections and for the treatment of prostatitis caused by sensitive bacteria. For chlamydialurethritis/cervicitis, a 7-day course of ofloxacin or sparfloxacin is an alternative to a 7-day course with doxycycline or a single dose of azithromycin .</li></li></ul><li>Uses of fluoroquinolones<br /><ul><li>Sexually Transmitted Diseases
  38. 38. A single oral dose of a fluoroquinolone such as ofloxacin or ciprofloxacin is effective treatment for sensitive strains of N. gonorrhoeae, but increasing resistance to fluoroquinolones has made ceftriaxone the first-line agent.
  39. 39. Bone, Joint, and Soft Tissue Infections
  40. 40. the fluoroquinolones in combination with an agent with antianaerobic activity are a reasonable choice for diabetic foot infections .
  41. 41. the fluoroquinolones have been used for the treatment of chronic osteomyelitis .</li></li></ul><li>Uses of fluoroquinolones<br /><ul><li> Respiratory Tract Infections
  42. 42. The major limitation to the use of quinolones for the treatment of community-acquired pneumonia and bronchitis was the pooractivityagainst S. pneumoniae and anaerobicbacteria. Many of the newer fluoroquinolones, including gatifloxacin and moxifloxacin, have excellent activity against S. pneumoniaeand have shown efficacy comparable to b-lactam antibiotics. The fluoroquinolones have activity against the rest of the common respiratory pathogens. .</li></li></ul><li>Uses of fluoroquinolones<br /><ul><li>Gastrointestinal and Abdominal Infections
  43. 43. Shigellosisis treated effectively with either ciprofloxacin or azithromycin .
  44. 44. For traveler’s diarrhea (frequently caused by enterotoxigenic E. coli), the quinolones are equal to trimethoprim–sulfamethoxazole in effectiveness .</li></li></ul><li>Practical notes<br />Pharmadevelop notes<br />Find the best information in<br />The easiest way<br />
  45. 45. Practical notes<br />Avoid co-administration of quinolones with antiacids – multivitamins – calciumpreparations (osteocare preparations)– iron preparations (anemia preparations)– and zinc preparations (antioxidant preparations ) ,if necessary ,take them after quinolones by 2 hours at lest.<br />The dose of caffeine , cyclosporin , theophylline & warfarin should be adjusted when they are taken with quinolones .<br />Acyclovir (Zovirax) : drug card<br />
  46. 46. Practical notes<br />For moxifloxacinand sparfloxacin , take with each oral dose a full glass of water to prevent crystal formation in the urine .<br />Ofloxacinto be taken on empty stomach (1 hour before or 2 hours after food ).<br />Gatifloxacin cause dizziness so , avoid driving operation or machinery .<br />Levofloxacin , ofloxacin , gatifloxacin , ciprofloxacin anddnorfloxacin require dosage adjustment in renal insufficiency because they are renally eliminated . But moxifloxacin don’t require .<br />Mechanism of action of fluoxetine (prozac) : video<br />
  47. 47. Rapid review<br />
  48. 48. Rapid review<br />Quinolones inhibit bacterial DNA gyraseand topoisomerase.<br />fluoroquinolones are bactericidal. In general, they are effective against gram-negative organisms and some gram-positive . But, poor active against anaerobic except the newer generations which have wider spectrum for gram-positive and anaerobes .<br />The main side effects of quinolones are nausea ,anorexia ,Arthropathy ,Nephrotoxicity and Phototoxicity .<br />Understanding of allergy : video<br />
  49. 49. Rapid review<br />The dose of most quinolones is twice daily . But the newer generations are used once daily .<br />Quinolones interact with Antiacids , minerals ,Sucralfate , warfarin, cyclosporine ,Theophyllineand caffeine.<br />Fluoroquinolones are contraindecated in pregnancy, nursing mothers and in children under 18 years .<br />ciprofloxacin is recommended for treatment of urinary tract infections , traveler’s diarrhea , prostatitis, typhoid fever .<br />Levofloxacin , moxifloxacin and gatifloxacinare called risperatoryquinolonesbecause they are active against different types of pneumonia .<br />Gallstones : rapid review<br />
  50. 50. Test yourself<br />Pharmacist Development<br />Enjoy learning <br />www.pharmacist-development.com<br />
  51. 51. Test yourself<br />Which is right :-<br /> 1- ciprofloxacin is the drug of choice for gonococcalurethritis .<br /> 2- lomefloxacin is the most effective agent for pseudomonalbacteremia.<br /> 3- moxifloxacin show increased activity against anaerobes, compared with ciprofloxacin .<br /> 4- norfloxacin is the better quinolones for systemic infections .<br />Understanding of myocardial infarction : video<br />
  52. 52. Test yourself<br />The active ingredient of Tavanic is :-<br /> 1- ciprofloxacin .<br /> 2- levofloxacin .<br /> 3- gatifloxacin .<br /> 4- moxifloxacin .<br />Erectile dysfunction : video<br />
  53. 53. Test yourself<br />The dose Norfloxacin is :-<br /> 1- 200 mg once daily .<br /> 2- 400 mg twice daily .<br /> 3- 400 mg once daily .<br /> 4- 200 mg twice daily .<br />Understanding of osteoporosis : video<br />
  54. 54. Test yourself<br />All the following are right about ciprofloxacin except :-<br /> 1- it is used forShigellosi .<br />2- it can be used for gonococcalurethritis .<br />3- it can be used for traveler diarrhea .<br />4- it can be used for S. pneumoniae .<br />The use and the action of Epipen : video<br />
  55. 55. resources<br />Drugs&Drugs-2ed .<br />Infectious Diseases A Clinical Short Course .<br />Drug – Drug Interactions .<br />Goodman & Gilman’s Manual of Pharmacology and Therapeutics .<br />Lippincott Illustrated Reviews_Pharmacology2ed .<br />LippincottIllustratedReviews_microbiology .<br />Pharmacology for the Health Care Professions .<br />Master of Egyption drugs 2008 .<br />
  56. 56. Easy microbiologyprogramme<br />Antibiotics course. 1-Quinolones<br />Preparation<br />Dr. Mohamed Nassar<br />Edited by<br />Preparation department<br />Revision<br />Scientific department<br />Art designing<br />Medica Designs<br />General supervisor<br />Dr. Mohamed Nassar<br />Produced by<br />Pharmacist development<br />group<br />2009<br />If you like this<br />lecture share it<br />with your friends<br />All rights reserved<br />MedicaDesigns<br />

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