The role of fluoroquinolones in the management of urinary tract infections in areas with high rates of fluoroquinolone-resistant uropathogens
Journal
European Journal of Clinical Microbiology and Infectious Diseases
Journal Volume
31
Journal Issue
8
Pages
1699-1704
Date Issued
2012
Author(s)
Abstract
Fluoroquinolones have been recommended as the drugs of choice for the empirical treatment of uncomplicated and complicated urinary tract infections (UTIs) caused by trimethoprim-sulfamethoxazole-resistant uropathogens. However, because of the increased use of both oral and parenteral fluoroquinolones for other kinds of infections, increasing rates of resistance to fluoroquinolones among the most common uropathogens have challenged this recommendation, particularly in the Asia-Pacific region. The current interpretative criteria for the in vitro susceptibility of uropathogens to some fluoroquinolones, such as levofloxacin and ciprofloxacin, are set according to their therapeutic efficacy for bloodstream infections, and are not specific to UTIs. Fluoroquinolones exhibit concentration-dependent antibacterial activity, high renal excretion, and relatively early and prolonged urinary bactericidal titers. Whether or not current interpretative criteria for the in vitro susceptibility of uropathogens to fluoroquinolones predict clinical failure in treating UTIs is still controversial. The Clinical and Laboratory Standards Institute (CLSI) has established UTI-specific breakpoints for resistance to a few fluoroquinolones. However, the application of high-dose fluoroquinolone therapy for the treatment of mild to moderate UTIs caused by isolates with higher minimum inhibitory concentrations (MICs) of several fluoroquinolones needs to be re-validated based on more relevant clinical studies, prudent pharmacokinetic/ pharmacodynamic (PK/PD) considerations, and thorough study of the mutant prevention concentration of fluoroquinolones in the treatment of UTI. ? Springer-Verlag 2011.
SDGs
Other Subjects
ampicillin; ciprofloxacin; cotrimoxazole; levofloxacin; lomefloxacin; norfloxacin; ofloxacin; quinoline derived antiinfective agent; trimethoprim; acute pyelonephritis; antibacterial activity; antibiotic resistance; antibiotic sensitivity; area under the curve; Asia; bactericidal activity; bacterium isolate; bacterium mutant; bloodstream infection; concentration response; coronary artery disease; depression; disease severity; drug choice; drug efficacy; drug excretion; drug megadose; drug treatment failure; drug withdrawal; hallucination; human; in vitro study; low drug dose; minimum inhibitory concentration; Pacific islands; prediction; priority journal; review; suicidal ideation; syncope; unspecified side effect; urinary excretion; urinary tract infection; Anti-Bacterial Agents; Asia; Bacterial Infections; Drug Resistance, Bacterial; Fluoroquinolones; Humans; Microbial Sensitivity Tests; Pacific Islands; Treatment Outcome; Urinary Tract Infections
Type
review