sitafloxacin and grepafloxacin

The currently available fluoroquinolones have modest activity against anaerobes. Newer fluoroquinolones with increased in vitro activity against anaerobes are under development and include levofloxacin, clinafloxacin, sparfloxacin, trovafloxacin, grepafloxacin, and DU-6859a. Side effects of the quinolones have varied according to the specific compounds and include central nervous system stimulation, gastrointestinal disturbances, vasculitis, and photosensitization. Monitoring for toxicity is incompletely reliable in identifying all potential serious side effects such as the "temafloxacin syndrome." Other fluoroquinolones may produce this syndrome rarely or not at all. In this paper, I review limited published studies on the use of these agents for skin and skin-structure infections and gynecologic infections. Studies in progress are noted, and when available, in vitro data on the efficacy of these agents against bacterial isolates from specific sources are reviewed and evaluated in terms of potential clinical utility.

Topics: Anti-Infective Agents; Bacteria, Anaerobic; Bacterial Infections; Fluoroquinolones; Humans; Levofloxacin; Naphthyridines; Ofloxacin; Piperazines; Quinolones; Safety; Syndrome

The in vitro activity of early fluoroquinolone antibodies--including ciprofloxacin, ofloxacin, fleroxacin, pefloxacin, enoxacin, and lomefloxacin--against most anaerobes has been limited, a characteristic making them poor choices as antianaerobic agents. Newer fluoroquinolones, including levofloxacin, sparfloxacin, and grepafloxacin, have moderate activity against anaerobes, including the Bacteroides fragilis group as well as Clostridium, Peptostreptococcus, Prevotella, and Fusobacterium species. Fluoroquinolones that demonstrate the greatest activity against the B. fragilis group and other anaerobes include DU-6859a, clinafloxacin, and the related naphthyridone, trovafloxacin. There has been wide variation in the susceptibility results among different studies testing the same antibiotic; such variation may be due in part to the use of different methodologies, inoculum sizes, and testing media. In a direct comparison of susceptibility findings for ciprofloxacin, ofloxacin, and levofloxacin in three different media, we have determined that twofold dilution differences in minimum inhibitory concentration (MIC) values (MIC90, mode MIC, and geometric mean MIC) may occur in association with the choice of testing media. Thus, testing media should be considered when comparing results of different studies on the susceptibility of anaerobes to fluoroquinolones.

Topics: Anti-Infective Agents; Bacteria, Anaerobic; Culture Media; Drug Resistance, Microbial; Evaluation Studies as Topic; Fluoroquinolones; Humans; In Vitro Techniques; Levofloxacin; Microbial Sensitivity Tests; Naphthyridines; Ofloxacin; Piperazines; Quinolones; United States

Several multilaboratory collaborative studies using broth microdilution and agar dilution (gonococcal tests only) methods of susceptibility testing were performed to establish quality-control (QC) giudelines. Replicate dilution tests with multiple lots of media were performed with National Committee for Clinical Laboratory Standards recommended QC strains (Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853, Enterococcus faecalis ATCC 29212, and Staphylococcus aureus ATCC 29213) by using the following antimicrobials: biapenem, DU-6859a, FK-037, levofloxacin, and grepafloxacin. In addition QC MIC ranges, using appropriate medium modification for Haemophilus influenzae ATCC 49247 and Neisseria gonorrhoeae ATCC 49226 were reported on four (DU-6859a, FK-037, levofloxacin, and grepafloxacin) and two (ceftizoxime and FK-037) antimicrobials, respectively.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Bacteria; Ceftizoxime; Fluoroquinolones; Levofloxacin; Microbial Sensitivity Tests; Ofloxacin; Piperazines; Quality Control; Quinolones; Reference Values; Spiro Compounds; Thienamycins