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 .

1. Pharmacist Development Group

2. Scientific Department Easy microbiology programme Present

3. antibiotics course1-Quinolones By Dr.MohamedNassar

4. The Lecture In Points

5. Quinolones general information Visit video department on pharmacist development website

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.

10. Fluoroquinolones action , side actions & interactions Refresh your information by medical reminder on pharmacist development website mean page

12. 200–400 mg every 12 hours for ofloxacin .

13. 400 mg every 12 hours for norfloxacin and pefloxacin .

14. 250–750mg every 12 hours for ciprofloxacin.

16. Allergicreactions(most common with gemifloxacin; less common with other quinolones).

17. Arthropathy and tendonitis. May damage cartilage. Not routinely recommended in children.

18. Gatifloxacin can cause hypo- or hyperglycemia.

19. Moxifloxacin prolongs the QT interval.

20. Nephrotoxicity: Crystalluria has been reported in patients receiving excessive doses (3-4 times normal).

22. Sucralfate:- Reduced gastrointestinal absorption of ciprofloxacin, norfloxacin, and probably other quinolones.

23. warfarin, cyclosporine and caffeine :- Ciprofloxacin, ofloxacin and enoxacin increase thier serum levels .

27. Ciprofloxacin is the most potent quinolone for P. aeruginosa.

28. Ciprofloxacin is one of the primary antibiotics recommended for treatment of urinary tract infections.

29. It concentrates in the prostate and is recommended for treatment of prostatitis.

30. For gonococcalurethritis, it is a useful alternative to ceftriaxone.

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. Ciprofloxacin has been used effectively for traveler’s diarrhea most commonly caused by enterotoxigenicE. coli and Shigella.

33. It is the drug of choice for Salmonella typhi (typhoid fever),

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. Bone, Joint, and Soft Tissue Infections

40. the fluoroquinolones in combination with an agent with antianaerobic activity are a reasonable choice for diabetic foot infections .

43. Shigellosisis treated effectively with either ciprofloxacin or azithromycin .

45. Practical notes 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. The dose of caffeine , cyclosporin , theophylline & warfarin should be adjusted when they are taken with quinolones . Acyclovir (Zovirax) : drug card

46. Practical notes For moxifloxacinand sparfloxacin , take with each oral dose a full glass of water to prevent crystal formation in the urine . Ofloxacinto be taken on empty stomach (1 hour before or 2 hours after food ). Gatifloxacin cause dizziness so , avoid driving operation or machinery . Levofloxacin , ofloxacin , gatifloxacin , ciprofloxacin anddnorfloxacin require dosage adjustment in renal insufficiency because they are renally eliminated . But moxifloxacin don’t require . Mechanism of action of fluoxetine (prozac) : video

47. Rapid review

48. Rapid review Quinolones inhibit bacterial DNA gyraseand topoisomerase. 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 . The main side effects of quinolones are nausea ,anorexia ,Arthropathy ,Nephrotoxicity and Phototoxicity . Understanding of allergy : video

49. Rapid review The dose of most quinolones is twice daily . But the newer generations are used once daily . Quinolones interact with Antiacids , minerals ,Sucralfate , warfarin, cyclosporine ,Theophyllineand caffeine. Fluoroquinolones are contraindecated in pregnancy, nursing mothers and in children under 18 years . ciprofloxacin is recommended for treatment of urinary tract infections , traveler’s diarrhea , prostatitis, typhoid fever . Levofloxacin , moxifloxacin and gatifloxacinare called risperatoryquinolonesbecause they are active against different types of pneumonia . Gallstones : rapid review

50. Test yourself Pharmacist Development Enjoy learning www.pharmacist-development.com

51. Test yourself Which is right :- 1- ciprofloxacin is the drug of choice for gonococcalurethritis . 2- lomefloxacin is the most effective agent for pseudomonalbacteremia. 3- moxifloxacin show increased activity against anaerobes, compared with ciprofloxacin . 4- norfloxacin is the better quinolones for systemic infections . Understanding of myocardial infarction : video

52. Test yourself The active ingredient of Tavanic is :- 1- ciprofloxacin . 2- levofloxacin . 3- gatifloxacin . 4- moxifloxacin . Erectile dysfunction : video

53. Test yourself The dose Norfloxacin is :- 1- 200 mg once daily . 2- 400 mg twice daily . 3- 400 mg once daily . 4- 200 mg twice daily . Understanding of osteoporosis : video

54. Test yourself All the following are right about ciprofloxacin except :- 1- it is used forShigellosi . 2- it can be used for gonococcalurethritis . 3- it can be used for traveler diarrhea . 4- it can be used for S. pneumoniae . The use and the action of Epipen : video

55. resources Drugs&Drugs-2ed . Infectious Diseases A Clinical Short Course . Drug – Drug Interactions . Goodman & Gilman’s Manual of Pharmacology and Therapeutics . Lippincott Illustrated Reviews_Pharmacology2ed . LippincottIllustratedReviews_microbiology . Pharmacology for the Health Care Professions . Master of Egyption drugs 2008 .

56. Easy microbiologyprogramme Antibiotics course. 1-Quinolones Preparation Dr. Mohamed Nassar Edited by Preparation department Revision Scientific department Art designing Medica Designs General supervisor Dr. Mohamed Nassar Produced by Pharmacist development group 2009 If you like this lecture share it with your friends All rights reserved MedicaDesigns