What are the respiratory fluoroquinolones (antibiotics)?

From the Guidelines

Respiratory fluoroquinolones, such as levofloxacin and moxifloxacin, are recommended for the treatment of community-acquired pneumonia, particularly in patients with allergies to other antibiotics or when first-line agents have failed, due to their effectiveness against common respiratory pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and atypical organisms 1. The main respiratory fluoroquinolones include levofloxacin (typically 750mg once daily for 5-7 days) and moxifloxacin (400mg once daily for 5-7 days). These medications work by inhibiting bacterial DNA gyrase and topoisomerase IV, preventing DNA replication and ultimately killing the bacteria. Some key points to consider when prescribing respiratory fluoroquinolones include:

• Contraindications, such as QT interval prolongation, tendon rupture risk, CNS effects, and potential for C. difficile infection
• Judicious use due to concerns about resistance development
• Reservation for situations where other antibiotics are inappropriate or have failed
• Patient advice to take the full course as prescribed, report any tendon pain immediately, and avoid antacids, iron, or multivitamins within 2 hours of taking these medications as they can reduce absorption. It's also important to note that the use of fluoroquinolones is increasingly being guided by concerns about resistance development, and their use should be tailored to the specific needs of the patient and the local epidemiology of resistance 1. In general, the choice of antibiotic should be based on the severity of the infection, the patient's underlying health status, and the likelihood of resistance to specific antibiotics 1. Some studies suggest that the use of fluoroquinolones may be associated with a lower risk of resistance development compared to other antibiotics, but this is still a topic of debate 1. Overall, respiratory fluoroquinolones are a valuable tool in the treatment of community-acquired pneumonia, but their use should be guided by careful consideration of the potential benefits and risks.

From the FDA Drug Label

The provided drug labels do not directly answer the question about respiratory fluoroquinolones. The FDA drug label does not answer the question.

From the Research

Respiratory Fluoroquinolones

• Respiratory fluoroquinolones, such as levofloxacin, are effective antibiotics for the treatment of lower respiratory tract infections, including community-acquired pneumonia (CAP) and acute exacerbations of chronic bronchitis (AECB) 2, 3, 4.
• Levofloxacin has a broad spectrum of activity against Gram-positive and Gram-negative organisms, including Streptococcus pneumoniae, and is effective against penicillin-resistant strains 2, 4.
• The efficacy and tolerability of levofloxacin 500 mg once daily for 10 days in patients with CAP is well established, and high-dose, short-course regimens (750 mg once daily for 5 days) have been shown to be noninferior to the 10-day regimen in CAP and acute bacterial sinusitis (ABS) 3, 5.

Pharmacokinetics and Tolerability

• Levofloxacin is rapidly absorbed and has good tissue penetration, with an adequate concentration maintained at the site of infection 3, 5.
• The pharmacokinetics of levofloxacin 500 mg once daily during sequential intravenous/oral therapy in patients with lower respiratory tract infections have been studied, and the results show a lower clearance and longer elimination half-life in elderly patients compared to healthy volunteers 6.
• Levofloxacin is generally well tolerated, with a good safety profile and low risk of adverse events, including phototoxicity, hepatic, and cardiac events 2, 3, 5.

Clinical Use

• Levofloxacin can be used as monotherapy in patients with CAP, but combination therapy with an anti-pseudomonal beta-lactam or aminoglycoside should be considered if Pseudomonas aeruginosa is the causative pathogen 3, 4.
• High-dose, short-course levofloxacin regimens may offer improved treatment outcomes due to higher drug concentrations, more rapid killing, and increased adherence, as well as reducing the potential for resistance development 3, 4, 5.
• Levofloxacin is a valuable antimicrobial agent with activity against a wide range of bacterial pathogens, but its use should be considered carefully to minimize the potential for resistance selection and maintain its usefulness in severe infections and against penicillin- and macrolide-resistant pathogens 2, 5.