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Bacterial infectious disease — Clinical Guidelines

Overview

Fluoroquinolones are broad-spectrum antibiotics commonly used to treat various bacterial infections, but their use is complicated by issues such as resistance development, drug interactions, and adverse drug reactions (ADRs). 1 2 4 5

Diagnosis

Clinical Presentation: Symptoms specific to the underlying infection.

Laboratory Tests: Cultures and sensitivity tests to confirm bacterial etiology and antibiotic susceptibility 2.

Monitoring for ADRs: Regular assessment for signs of adverse reactions, particularly cutaneous and musculoskeletal issues 4 5.

Management

First-Line Treatments: Fluoroquinolones (e.g., levofloxacin, ciprofloxacin) for severe or resistant infections 2.

Adjunctive Measures: Avoid coadministration with di- or tri-valent cation-containing compounds (DTCCs) to prevent impaired absorption 2.

Monitoring: Close monitoring for adverse drug reactions, especially in high-risk populations 4 5.

Special Populations

Elderly: Increased risk of tendon ruptures and other ADRs; cautious use recommended 5.

Comorbidities: Patients on corticosteroids have heightened risk of tendon disorders 5.

Key Recommendations

Avoid Coadministration of DTCCs with Fluoroquinolones to ensure optimal drug absorption and efficacy (Evidence: Moderate 2).

Regular Monitoring for ADRs, particularly cutaneous and musculoskeletal issues, is crucial in patients receiving fluoroquinolones (Evidence: Moderate 4 5).

Exercise Caution in High-Risk Groups, such as the elderly and those on corticosteroids, due to increased susceptibility to severe adverse reactions (Evidence: Expert opinion 5).

References

1 Al Lawati HJ, Harvey KL, Shin M, Mull H, Lamkin RP, Golenbock S et al.. Operationalizing an adverse event detection surveillance system to support antimicrobial stewardship activities: perceptions and insights from the SHEA research network. Infection control and hospital epidemiology 2024. link 2 Barton TD, Fishman NO, Weiner MG, LaRosa LA, Lautenbach E. High rate of coadministration of di- or tri-valent cation-containing compounds with oral fluoroquinolones: risk factors and potential implications. Infection control and hospital epidemiology 2005. link 3 Holtzapple CK, Buckley SA, Stanker LH. Determination of fluoroquinolones in serum using an on-line clean-up column coupled to high-performance immunoaffinity-reversed-phase liquid chromatography. Journal of chromatography. B, Biomedical sciences and applications 2001. link00575-2) 4 Uppal R, Jhaj R, Malhotra S. Adverse drug reactions to fluoroquinolones at a tertiary care hospital in northern India. The Journal of the Association of Physicians of India 1998. link 5 Royer RJ. Adverse drug reactions with fluoroquinolones. Therapie 1996. link 6 Ross GW, Boulton MG. Improvement of the specificity of an antiserum to -lactamase by absorption with a mutant which does not produce the enzyme. Journal of bacteriology 1972. link

Bacterial infectious disease