Fluoroquinolones

Question 1

What are the 4 fluoroquinolones? classify them according to newere and older generation.
- what’s the roa of cipro, levo, and moxifloxacin?
- in GENEREAL terms, what is their main areas of activity?

Answer 1

older generations:
1) norfloxacin (urine) - enterobacterales.

2) Cipro - enterobacterales,psuedomonas (PO, IV, opth)

Newer gens:
3) Levofloxacin - S. pneum, enterobacterales, pseudomonas.
( IV, PO)

4) Moxifloxacin-S. pneum, enterobacterales, ***ANAEROBES (loses pseudomonas coverage, but gains ANAEROBIC coverage)
* think: M for Metronidazole = covers anaerobes.
(IV, PO, opth)

Question 2

What is the only FQ that DOES NOT cover pseudomonas?

Answer 2

Moxi

Question 3

In GENERAL terms, describe the older generations (cipro) G- and G+ coverage?

Answer 3

• more reliabel for Gram negatives, POOR gram pos coverage.

Question 4

For the OLDER FQ’s Cipro (and norflox), describe the following activity against:
- G+
- G-
- which 3 diarrheal causing organisms?
- which 2 notable weird ones?
-atypicals?
- anaerobes?

Answer 4

(G+) - VERY POOR (dont use empirically)
(G-) - EXCELLENT {THINK: QUynh is v. negative -> Gram negative coverage mainly; levo and moxi have imporved gram pos coverage!!}
i) Enterobacteraciae (recall: CEEK ShYPS): HENPEK + serratia + citrobacter
ii) diarrhea ones: Salmonella, shigella, campylobacter.
iii) weird, dramatic ones: anthrax, yersinia pestis
iv) other gram negs: psuedomonas, N. meningitidis, N. gonorrhea, M. cat (moraxella was previously neisseria).

(which 3 diarrheal causing organisms?)
(which 2 notable weird ones?)
- atypicals: no coverage
- anaerobes: POOR coverage.

Question 5

What are the main memebrs of the ENTEROBACTERACIAE FAM? Acronym to remember?

Answer 5

*the enterobacteraciae CEEK ShyPS

1) Citrobacter
2) Eschericia
3) Enterobacter
4) Klebsiella

1) Shigella
2) Yersinia
3) Proteus
4) Providencia
5) salmonella

Question 6

What is the main use of Cipro?

Answer 6

1) for MORE SERIOUS Gram Neg infections as PO or step down!!
2) useful ALTERNATIVE TO AMINOGLYCOSIDES if renal damage a concern in susceptible gram neg infections.
3) for PSEUDOMONAS ACTIVITY.

Question 7

How is coverage for the NEWWER FQ’S different from the older ones?

in terms of G+, G-, atypical, anaerobic coverage (moxi vs levo?)

Answer 7

• newer ones have IMPROVED GRAM POSITIVE and ATYPICAL coverage. –> improved activity against: Staph aureaus, S. pneumonia. Mycoplasma. pneum, Chlamydia. pneum.

G- : similar G- coverage as cipro.
Anaerobes:
i) Moxi - EXCELLENT
ii) Levo- not good, but has psuedomonas coverage instead.

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