Fluoroquinolones

1. 3rd generation:

1.1. Levofloxacin (PO, IV)

1.2. Gm +ve: MSSA, S. Pneumonia (except ciprofloxacin) Gm -ve: Entering GNRs, H. influenza, p. aeruginosa (only cipro & levo) Atypical: mycoplasma, chlamydia, legionella Acid fast: TB (only levofloxacin)

2. 4th generation:

2.1. Moxifloxacin (PO, IV) Gemifloxacin (PO) Delafloxacin (PO, IV)

2.2. SAME 2ND AN 3RF G + Anaerobes (only moxifloxacin) TB (only moxifloxacin) MRSA (only Delafloxacin)

3. Note: o DDI: inhibits P450 enzyme and increases plasma levels of theophylline and warfarin. o Levofloxacin, ciprofloxacin: oral alternatives for pseudomonas infections. o Moxifloxacin: • Hepatic elimination, no need for renal dose adjustment • Not used for UTI due to poor penetration

4. SIDE EFFECTS 1. CNS: dizziness, confusion, and hallucinations (Elderly) or insomnia (Younger patients). 2. Peripheral neuropathy 3. Prolongation of the QT interval 4. Tendonitis. 5. Tendon rupture (more common in the elderly, patients with renal dysfunction, and those taking corticosteroids) 6. Photosensitivity. 7. Hepatotoxicity. 8. Visual disturbance. 9. Dysglycemia (more with moxifloxacin)

5. 1st generation (quinolones):

5.1. Nalidixic acid

5.2. Gm -ve: enteric GNR

6. 2nd generation:

6.1. Ciprofloxacin (PO, IV) Norfloxacin (PO) Ofloxacin (PO)

6.2. Gm +ve: MSSA, S. Pneumonia (except ciprofloxacin) Gm -ve: Entering GNRs, H. influenza, p. aeruginosa (only cipro & levo) Atypical: mycoplasma, chlamydia, legionella Acid fast: TB (only levofloxacin)