THE FUTURE-ROLE OF QUINOLONES

Quinolones, such as ciprofloxacin and ofloxacin, have gained wide acce ptance for the treatment of bacterial infections of the respiratory tr act, urinary tract, skin and soft tissues, as well as sexually transmi tted diseases. Good pharmacokinetic profiles and potent activities aga inst a wide range of Gram-negative and Gram-positive pathogens result in the use of these antibacterials in both hospital and community sett ings. Although recently developed clinical quinolones dominate in the chemotherapy of various bacterial infections, their use is restricted by limited activities against a number of clinically-important Gram-po sitive bacteria such as Streptococcus pneumoniae, Streptococcus pyogen es, Staphylococcus aureus, and enterococci. Ciprofloxacin, the market leader, also has low potency against anaerobes. Bacterial resistance ( such as in Pseudomonas aeruginosa and methicillin-resistant Staphyloco ccus aureus) to ciprofloxacin is increasing rapidly. Many quinolone co mpounds are being synthesised to address these drawbacks. The new quin olones currently under development are characterised by enhanced activ ities against streptococci, staphylococci, enterococci and anaerobes. Although the treatment of traditional bacterial infections is at prese nt the focus of quinolone research, the future role of quinolones will extend current applications to include new indications of bacterial i nfections and other non-bacterial diseases. This review will concentra te on the more recently developed quinolones which possess significant ly more therapeutic value than existing quinolones, and will provide i nformation on those compounds under commercial development with major therapeutic potential. Recent developments in research into the identi fication of quinolones for the treatment of tuberculous, cancer, viral , fungal infections and parasitic diseases will also be discussed.