CLINICAL-APPLICATIONS OF QUINOLONES

The quinolone antimicrobials are the class of inhibitors of bacterial topoisomerases that has been developed most fully for clinical use in human medicine. Initial members of the class had their greatest potenc y against Gram-negative bacteria, but newly developed members have exh ibited increased potency against Gram-positive bacteria and soon agent s will be available with additional activity against anaerobic bacteri a, providing a broad spectrum of potency. After nalidixic acid, the ea rliest member of the class which was used for treatment of urinary tra ct infections, the later fluoroquinolone congeners have had sufficient potency, absorption, and distribution into tissue for additional uses in treatment of sexually transmitted diseases, infections of the gast rointestinal tract, respiratory tract, skin, and bones and joints. Tol erability of these agents in usual doses has been good. Acquired bacte rial resistance resulting from clinical uses has occurred in particula r among staphylococci and Pseudomonas aeruginosa. Intense drug use and ability of resistant pathogens to spread have also contributed to dev elopment of resistance in initially more susceptible pathogens such as Escherichia coli and Neisseria gonorrhoeae in certain settings. Prese rvation of the considerable clinical utility of the quinolone class fo r the long term will be affected by the extent to which their use is j udicious. 0167-4781/98/$ - see front matter (C) 1998 Elsevier Science B.V. All rights reserved.