• 

Norfloxacin is used to treat UTIs and

Fluoroquinolones
prostatitis
 Structurally similar synthetic antibacterial
• Ofloxacin is used to treat selected sexually
drugs.   
transmitted diseases, lower respiratory tract
 They're primarily administered to treat
infection, skin infections and prostatitis.
UTIs, upper respiratory tract infections,
Gatifloxacin is use to treat condition like
pneumonia and gonorrhoea.
respiratory tract infections, soft tissue
- medicines that kill bacteria or prevent their
infections, UTI.
growth .
Sparfloxacin is indicated in condition like acne,
bacterial infections, bronchitis, pneumonia
Examples of fluoroquinolones:
tonsillitis.
• Cifrofloxacin
• Gemifloxacin
Adverse Reactions
• Levofloxacin
- Fluoriquinolones are well tolerated by most
• Moxifloxacin
patients, but some adverse effects may occur,
• Norfloxacin
including:
• Ofloxacin
• Dizziness
•gatifloxacin
• Nausea and vomiting
•sparfloxacin
• Diarrhea
 
• Abdominal pain.
Pharmacokinetic
 After oral administration, fluoroquinolones
Nursing considerations
are absorbed well. They aren’t highly
Assessment
protein bound, minimally metabolized in the
·        History: Allergy to fluoroquinolones, renal
liver, and are excreted primarily in the
dysfunction, seizures, lactation, pregnancy
urine.
·        Physical: Skin color, lesions; T;
Pharmacodynamics
orientation, reflexes, affect; mucous
 Bacteriostatic
membranes, bowel sounds; renal and liver
 Fluoroquinolones interrupt DNA synthesis
function tests; blood glucose (diabetics)
during bacterial replication by inhibiting
 
DNA gyrase, an essential enzyme of
Interventions
replicating DNA. As a result, the bacteria
·        Arrange for culture and sensitivity tests
can’t reproduce.
before beginning therapy.
 
·        Continue therapy as indicated for
Pharmacotherapeutics
condition being treated.
- Fluoroquinolones can be used to treat a wide
·        Administer oral drug 1 hr before or 2 hr
variety of UTIs.
after meals with a glass of water; separate oral
• Ciprofloxacin is used to treat lower
drug from other cation administration, including
respiratory tract infections, infectious diarrhea
antacids, by at least 2 hr.
and skin, bone and joint infection.
·        Ensure that patient is well hydrated
• Gemifloxacin is used to treat bronchitis,
during course of therapy.
community acquired pneumonia, UTIs, and
·        WARNING: Discontinue drug at any sign
gynaecologic infections.
of hypersensitivity (rash, photophobia) or at
• Levofloxacin is indicated for treatment of
complaint of tendon pain, inflammation, or
lower respiratory tract infections, skin
rupture.
infections and UTIs.
·        Monitor clinical response; if no
• Moxifloxacin is used to treat bacterial
improvement is seen or a relapse occurs, repeat
sinusitis and mild to moderate community
culture and sensitivity test.
acquired pneumonia.
 (pseudomembranous colitis), especially that due to the
exhibit concentration-dependent bactericidal activity by inhibiting
hypervirulent C. difficileribotype 027.
the activity of DNA gyrase and topoisomerase, enzymes essential
Diarrhea, leukopenia, anemia, and photosensitivity are
for bacterial DNA replication. Fluoroquinolones are divided into 2
groups, based on antimicrobial spectrum and pharmacology: uncommon. Rash is uncommon unless gemifloxacin is used for > 1
 Fluoroquinolone use for pneumon Older
wk and is more likely to develop in women < 40. Nephrotoxicity is
group: Ciprofloxacin 
, norfloxacin  rare.
, andofloxacin 
Newer group: Gemifloxacin 
, levofloxacin  Fluoroquinolones interfere with bacterial DNA metabolism by
andmoxifloxacin  the inhibition of two enzymes, Topoisomerase II (syn. DNA
Some newer fluoroquinolones have been withdrawn because gyrase) and Topoisomerase IV. In Gram-negative organisms
of toxicity; they include trovafloxacin (because of severe
hepatic toxicity) and gatifloxacin  DNA gyrase is the primary target, whereas in Gram-positive
(because of hypoglycemia and hyperglycemia). bacteria Topoisomerase IV was recently found to be most
affected.
ia is increasing, and with it so is bacterial resistance to
fluoroquinolones. The function of DNA gyrase is to introduce supercoils into
the linear DNA double helix, which results in the highly
Pharmacology
condensed 3-dimensional structure of the DNA usually
Oral absorption is diminished by coadministration of cations present inside the cell. The function of Topoisomerase IV still
(aluminum, Mg, Ca, zinc, and iron preparations). After oral and is barely understood.

parenteral administration, fluoroquinolones are widely distributed
in most extracellular and intracellular fluids and are concentrated
in the prostate, lungs, and bile.
Most fluoroquinolones are metabolized in the liver and excreted
in urine, reaching high levels in urine. Moxifloxacin is eliminated
primarily in bile.
Fluoroquinolones have traditionally been considered to be
contraindicated in children because they may cause cartilage
lesions if growth plates are open. However, some experts, who
challenge this view because evidence is weak, have recommended
prescribing fluoroquinolones as a 2nd-line antibiotic and
restricting use to a few specific situations, including P.
aeruginosa infections in patients with cystic fibrosis, prophylaxis
and treatment of bacterial infections in immunocompromised
patients, life-threatening multiresistant bacterial infections in
neonates and infants, and Salmonella or Shigella GI tract
infections.
Models to explain the activity of quinolones at the target site
only exist for DNA gyrase: During the supercoiling process,
both DNA strands are cleaved by DNA gyrase at 4 base pair
staggered sites, forming a "quinolone binding pocket".
Two quinolone molecules self-assemble inside the pocket in
dimer structure and attach to the gyrase-DNA complex
electrostatically, which stabilizes the intermediate stage of
this reaction step.
Permanent gaps in the DNA strands induce synthesis of
repair enzymes (exonucleases), initiating uncoordinated
repair processes, which results in irreversible damage to the
DNA and, finally, cell death.

 Upper GI adverse effects occur in about 5% of patients

because of direct GI irritation and CNS effects.
 CNS adverse effects (eg, mild headache, drowsiness,
insomnia, dizziness, mood alteration) occur in < 5%. NSAIDs
may enhance the CNS stimulatory effects of
fluoroquinolones. Seizures are rare, but fluoroquinolones
should not be used in patients with CNS disorders.
 Tendinopathy, including rupture of the Achilles
tendon, may occur even after short-term use of
fluoroquinolones.
 QT-interval prolongation can occur, potentially leading
to ventricular arrhythmias and sudden cardiac death.
 Fluoroquinolone use has been strongly associated
with Clostridium difficile–associated diarrhea