What is the list of fluoroquinolones?

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List of Fluoroquinolones

The fluoroquinolones include ciprofloxacin, levofloxacin, moxifloxacin, gatifloxacin, gemifloxacin, ofloxacin, norfloxacin, and delafloxacin, which are categorized into different generations based on their antimicrobial spectrum and development timeline. 1

Classification by Generation

First Generation

  • Nalidixic acid (prototype quinolone, approved by FDA in 1964)

Second Generation

  • Ciprofloxacin
  • Levofloxacin
  • Ofloxacin
  • Norfloxacin

Third Generation

  • Gemifloxacin (increased activity against Streptococcus pneumoniae while maintaining activity against many Gram-negative pathogens)

Fourth Generation

  • Moxifloxacin (increased activity against anaerobes while maintaining Gram-positive and Gram-negative activity)
  • Gatifloxacin
  • Delafloxacin

Antimicrobial Spectrum

  • Second-generation agents have greater Gram-negative spectrum with activity against Pseudomonas aeruginosa 1
  • Third-generation agents provide substantially increased activity against Streptococcus pneumoniae, Mycoplasma pneumoniae, and Chlamydophila pneumoniae 1
  • Fourth-generation agents display increased activity against anaerobes while maintaining the Gram-positive and Gram-negative activity 1

Clinical Applications

Fluoroquinolones are used for various infections including:

  • Urinary tract infections (UTIs) caused by E. coli, Pseudomonas aeruginosa, Enterobacter species, Citrobacter species, and Serratia species 1
  • Respiratory infections (pneumonia, acute otitis media, sinusitis) 1
  • Gastrointestinal infections (Salmonella, Shigella) 1
  • Tuberculosis (levofloxacin, moxifloxacin, gatifloxacin) 1
  • Plague (ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin) 1

Important Safety Considerations

  • Fluoroquinolones can cause QT interval prolongation and should be avoided in patients with known QT prolongation, uncorrected electrolyte abnormalities, or those receiving Class IA or III antiarrhythmic agents 2
  • Tendinitis and tendon ruptures can occur during treatment or months after treatment, particularly in patients >60 years, those with chronic renal disease, or those using corticosteroids 2
  • CNS effects including dizziness, insomnia, tremulousness, and headache may occur and require careful monitoring, especially in elderly patients 2
  • Contraindicated in children, adolescents, and pregnant women due to potential effects on cartilage development 3
  • Several fluoroquinolones have been withdrawn from the market due to serious adverse effects:
    • Clinafloxacin (phototoxicity and hypoglycemia)
    • Grepafloxacin (QTc prolongation and torsades de pointes)
    • Sparfloxacin (phototoxicity)
    • Trovafloxacin (hepatotoxicity) 4

Clinical Pearls

  • Ciprofloxacin maintains the best in vitro activity against Pseudomonas aeruginosa among the fluoroquinolones 4
  • Absorption can be impaired by aluminum- or magnesium-containing antacids and by zinc, iron, or calcium supplements 3
  • Increasing bacterial resistance to fluoroquinolones is a concern, particularly with increased use 1
  • Use should be restricted to situations where there is no safe and effective alternative to treat multidrug-resistant bacteria or when parenteral therapy is not feasible 1

The appropriate selection of a fluoroquinolone should be based on the specific pathogen, site of infection, patient factors, and local resistance patterns to optimize outcomes in terms of morbidity and mortality.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

The fluoroquinolones.

Mayo Clinic proceedings, 1991

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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