Pediatric Annals

CME Article 

Pediatric Uses of Fluoroquinolone Antibiotics

Thomas S. Murray, MD, PhD; Robert S. Baltimore, MD

  • Pediatric Annals. 2007;36(6)
  • Posted June 1, 2007

Abstract

Fluoroquinolone antibiotics have found widespread use in adults because of a favorable safety record, ease of administration (oral and intravenous forms available), and activity against a broad spectrum of gram-negative and gram-positive bacteria. Fluoroquinolones are derived from the first-generation quinolone, nalidixic acid, introduced into clinical practice in the 1960s. The addition of a fluorine to the quinolones created the second-generation fluoroquinolones, such as ciprofloxacin and levofloxacin. These drugs have a broader spectrum of antimicrobial activity compared with nalidixic acid, particularly against gram-negative bacteria, and improved pharmacokinetics. Further chemical modification resulted in the third- and fourth-generation quinolones, such as moxifloxacin, with expanded coverage to include gram-positive and anaerobic organisms. The classification of certain quinolones as either third- or fourth-generation is somewhat arbitrary and varies among references.

ABOUT THE AUTHORS

Thomas S. Murray, MD, PhD, is Postdoctoral Fellow in Pediatric Infectious Diseases, Yale University School of Medicine, New Haven, CT. Dr. Robert S. Baltimore, MD, is Professor of Pediatrics and Epidemiology, Yale University School of Medicine, Department of Pediatrics, Section Infectious Diseases, New Haven, CT.

Address correspondence to Robert S. Baltimore MD, Department of Pediatrics, Yale University School of Medicine, Box 208064, New Haven, CT 06520-8064; fax 203-785-7194; or e-mail robert.baltimore@yale.edu.

Dr. Baltimore and Dr. Murray disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

  1. Assess the safety data regarding the use of fluoroquinolones for children.
  2. Review the mechanisms and risk factors for microbial resistance to fluoroquinolones.
  3. Describe the recommended clinical indications for use of fluoroquinolones for children.

Abstract

Fluoroquinolone antibiotics have found widespread use in adults because of a favorable safety record, ease of administration (oral and intravenous forms available), and activity against a broad spectrum of gram-negative and gram-positive bacteria. Fluoroquinolones are derived from the first-generation quinolone, nalidixic acid, introduced into clinical practice in the 1960s. The addition of a fluorine to the quinolones created the second-generation fluoroquinolones, such as ciprofloxacin and levofloxacin. These drugs have a broader spectrum of antimicrobial activity compared with nalidixic acid, particularly against gram-negative bacteria, and improved pharmacokinetics. Further chemical modification resulted in the third- and fourth-generation quinolones, such as moxifloxacin, with expanded coverage to include gram-positive and anaerobic organisms. The classification of certain quinolones as either third- or fourth-generation is somewhat arbitrary and varies among references.

ABOUT THE AUTHORS

Thomas S. Murray, MD, PhD, is Postdoctoral Fellow in Pediatric Infectious Diseases, Yale University School of Medicine, New Haven, CT. Dr. Robert S. Baltimore, MD, is Professor of Pediatrics and Epidemiology, Yale University School of Medicine, Department of Pediatrics, Section Infectious Diseases, New Haven, CT.

Address correspondence to Robert S. Baltimore MD, Department of Pediatrics, Yale University School of Medicine, Box 208064, New Haven, CT 06520-8064; fax 203-785-7194; or e-mail robert.baltimore@yale.edu.

Dr. Baltimore and Dr. Murray disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

  1. Assess the safety data regarding the use of fluoroquinolones for children.
  2. Review the mechanisms and risk factors for microbial resistance to fluoroquinolones.
  3. Describe the recommended clinical indications for use of fluoroquinolones for children.

Fluoroquinolone antibiotics have found widespread use in adults because of a favorable safety record, ease of administration (oral and intravenous forms available), and activity against a broad spectrum of gram-negative and gram-positive bacteria. Fluoroquinolones are derived from the first-generation quinolone, nalidixic acid, introduced into clinical practice in the 1960s. The addition of a fluorine to the quinolones created the second-generation fluoroquinolones, such as ciprofloxacin and levofloxacin. These drugs have a broader spectrum of antimicrobial activity compared with nalidixic acid, particularly against gram-negative bacteria, and improved pharmacokinetics. Further chemical modification resulted in the third- and fourth-generation quinolones, such as moxifloxacin, with expanded coverage to include gram-positive and anaerobic organisms. The classification of certain quinolones as either third- or fourth-generation is somewhat arbitrary and varies among references.

ABOUT THE AUTHORS

Thomas S. Murray, MD, PhD, is Postdoctoral Fellow in Pediatric Infectious Diseases, Yale University School of Medicine, New Haven, CT. Dr. Robert S. Baltimore, MD, is Professor of Pediatrics and Epidemiology, Yale University School of Medicine, Department of Pediatrics, Section Infectious Diseases, New Haven, CT.

Address correspondence to Robert S. Baltimore MD, Department of Pediatrics, Yale University School of Medicine, Box 208064, New Haven, CT 06520-8064; fax 203-785-7194; or e-mail robert.baltimore@yale.edu.

Dr. Baltimore and Dr. Murray disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

  1. Assess the safety data regarding the use of fluoroquinolones for children.
  2. Review the mechanisms and risk factors for microbial resistance to fluoroquinolones.
  3. Describe the recommended clinical indications for use of fluoroquinolones for children.

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