Use: UTI

Mechanism: works best at pH 5.5, probably interferes with bacterial enzymes

Spectrum: E. coli, s. pyogenes, Citrobacter, Klebsiella, Enterobacter, Salmonella, Shigella, Serratia, Proteus (indole +); most proteus organisms and pseudomonas ar resistant

Tox: colors urine brown, interstitial pulmonary fibrosis, severe polyneuropathies (tox likely from long term use)

Contraindications: pregnancy, impaired renal function, allergy

Use: UTI

Mechanism: decomposes to formaldehyde and ammonia in UT; formaldehyde binds amino groups, inactivating proteins of bacteria

Abx spectrum: Gram - organisms (E.coli); resistance does not develop

1st Gen Fluoroquinolone

UTIs and prostatitis

2nd Gen Fluoroquinolone

Use: Soft tissue infections; anthrax prophylaxis; TB, M kansasii, M. fortuitum, systemic infections/UTI's; lower resp. tract infections, infections of skin, bones and joints; 

Mechanism: inhibition of DNA gyrase of the susceptible bacteria

Spectrum: Broad spectrum Gram + and -; notably pseudomonas aeruginosa, MRSA; E. coli, klebsiella pneumoniae, enterobacter cholerae, proteus mirabilis, P. vulgaris, pseudomonas aeruginosa, staphylococcus aureus, staphylococcus epidermidis, streptococcus marcescens, providencia rettgeri, morganella morganii, salmonella sp, shigella, campylobacter, yersinia sp, vibrio

PHK: Mg Interfere with absorption; poorly penetrates CSF

Adverse rxns: GI distrubances; all quinolones Increase QT interval; transient elevations of serum transaminase, LDH, alkaline phosphatases etc; tendon rupture

Resistance: altered target

Other Drugs: Levofloxacin (Levaquin®) Ofloxacin (Floxin®)

3rd Gen Fluoroquinolone

Oral once a day broad spec fluroquinolone

Use: acute exacerbations of chronic bronchitis, acute sinusitis, pneumonia; penecillin resistant S. pneumoniae

Mechanism: inhibits bacterial topoisomerase II (DNA gyrase) and topoisomerase IV

PHK: good penetration into respiratory tissue; metabolized in liver (glucuronide, sulfate conjugation); avoid in moderate/severe hepatic insufficiency

Other Drugs: Gatifloxacin (Zymar® ophthalmic only) - only topical for ocular infection

Gemifloxacin (Factive®)