LEVOFLOXACIN AND SPARFLOXACIN - NEW QUINOLONE ANTIBIOTICS

OBJECTIVE: To discuss the pharmacology, pharmacokinetics, spectrum of activity, clinical trials, and adverse effects of levofloxacin and spa rfloxacin, two new fluoroquinolone antibiotics. DATA SOURCES: Literatu re was identified by a MEDLINE search from January 1985 to September 1 997. Abstracts and presentations were identified by review of program abstracts from the Interscience Conference on Antimicrobial Agents and Chemotherapy from 1988 to 1996. STUDY SELECTION: Randomized, controll ed clinical studies were selected for evaluation; however, uncontrolle d studies were included when data were limited for indications approve d by the Food and Drug Administration (FDA). In vitro data were select ed from comparison trials whenever available. Only in vitro trials tha t provided data on the minimum inhibitory concentrations required to i nhibit 90% of isolates were used, Data from North American studies wer e selected whenever available. DATA EXTRACTION: Data were evaluated wi th respect to in vitro activity, study design, clinical and microbiolo gic outcomes, and adverse drug reactions. DATA SYNTHESIS: Levofloxacin and sparfloxacin are active against pathogens frequently involved in community-acquired upper and lower respiratory tract infections, inclu ding Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catar rhalis, Mycoplasma pneumoniae, Legionella pneumophila, and Chlamydia p neumoniae. Both compounds have enhanced activity compared with ciprofl oxacin against most gram-positive bacteria, including enterococci, str eptococci, and staphylococci, and retain good activity against most En terobacteriaceae and Pseudomonas aeruginosa, Sparfloxacin has greater anaerobic activity than levofloxacin, which is more active than ciprof loxacin ol ofloxacin, Although many clinical studies are available onl y in abstract form, the clinical data demonstrate that these new quino lones are effective for most community-acquired upper and lower respir atory tract infections, urinary tract infections, gonococcal and nongo nococcal urethritis, and skin and skin structure infections. FDA-appro ved indications are limited for both compounds to date, CONCLUSIONS: L evofloxacin and sparfloxacin have improved grampositive activity compa red with that of older fluoroquinolones, and are administered once dai ly, Sparfloxacin-associated photosensitivity may limit its therapeutic usefulness. Clinical trials confirm that these agents are as effectiv e as traditional therapies for the management of community-acquired pn eumonia, acute exacerbations of chronic bronchitis, sinusitis, urinary tract infections, acute gonococcal and nongonococcal urethritis, and skin and skin structure infections.