FLUOROQUINOLONES AND BACTERIAL ENTERITIS, WHEN AND FOR WHOM

During the last decade quinolones such as norfloxacin, ciprofloxacin, ofloxacin and fleroxacin have emerged as drugs of choice for treatment of various bacterial enteric infections. Controlled studies have show n that quinolones, administered in varying regimens ranging from a sin gle dose to 5 days treatment, significantly reduce the intensity and s everity of travellers' diarrhoea as well as shigellosis. They have als o been found to be highly effective in the treatment of invasive non-t yphoid salmonellosis as well as typhoid fever. Results from trials eva luating quinolone treatment of uncomplicated salmonella and campylobac ter enteritis have generally been disappointing. We studied norfloxaci n for the empirical treatment of suspected bacterial enteritis of less than 6 days duration in a large placebo controlled trial. Although st atistical differences in clinical outcome favouring norfloxacin were f ound among 259 culture positive patients, the differences were not str iking and of doubtful clinical importance. However, a dear beneficial effect of norfloxacin, resembling that observed in early treatment of travellers' diarrhoae was found among the severely ill patients who in itiated treatment within 48 h of onset of illness. Patients whose illn ess was present for >48 h before starting treatment failed to show any clinical benefit from norfloxacin. Thus, the interval from onset of s ymptoms to start of treatment seemed to be of major importance in rela tion to therapeutic efficacy. Quinolone treatment of bacterial enterit is is furthermore limited by the rapid development of resistance seen in Campylobacter spp, and the failure of these compounds to eradicate Salmonella spp. Presently quinolones can be recommended in treatment o f travellers' diarrhoea and shigellosis as well as enteric fever. They have limited usefulness for the routine empirical treatment of bacter ial enteritis caused by Salmonella spp and Campylobacter spp. Treatmen t should be restricted to early empirical treatment of the severely il l and vulnerable patients with an underlying health problem.