CIDAL

Mostly G -, some Gram +

Mechanisms

G -:  inhibits DNA gyrase

G +: inhibits topoisomerase IV 

Ends in -floxacin

2nd gen FQ

Less active for S. pneumoniae

Forms: opthalmic = CILOXAN, otpic = CIPRO

Best FQ for G -

Rx Reactions:

• DEC theophylline (bronchodilator) clearance --> toxicity & arrythmias.  Narrow window therapeutic effect.
• Inhibits CYP3A4 & CYP1A2 --> INC methadone (opiod) and tizanidine, respectively --> resp depression, sedation, hypotension, hallucinations

2nd gen FQ

Less active for S. pneumoniae

Least active, UTI only

2nd gen FQ

Less active for S. pneumoniae

Oral generic. OCUFLOX = opthalmic 

3rd gen FQ

More active against S. pneumoniae

Opthalmic ONLY

3rd gen Respiratory FQ

Nothing special fr other FQs

3rd gen Respiratory FQ

Most active against S. pneumoniae

Isomer of Ofloxacin

SIDE EFFECTS:

INC risk prolongn Q-T interval in elderly --> Torsades de pointest - arrythmias (effects on K channels)

FDA: risk of acute hepatitis & fatal events (rare)

3rd gen Respiratory FQ

More active against S. pneumoniae

Opthalmic = VIGAMOX.  Metabolized by liver - caution if liver disease.

SIDE EFFECTS:

Prolong Q-T interval in healthy pts

4th gen FQ

bacterial conjunctivitis

• Phototoxicity - burning, redness, swelling, blisters, rash, itch
• Arthropathy - damage growing cartilage; avoid in kids/pregnant
• Tendon rupture - BLACK BOX WARNING (BBW) - strongest warning, for 65+ yo, takn steroids
• Diabetics - INC/DEC blood sugar if taking w/insulin or oral hypoglycemic
• CNS stimulation - convulsions, anxiety
• Diplopia??
• NVD (nausea, vomiting, diarrhea) - major cause of C-diff induced diarhea & pseudomembranous colitis; C. diff survives as spores, grows w/o competition --> causes fluid secretion, inflamm, etc.

FQ Rx Interaction:

• Avoid antacids & Fe supps --> DEC absorption