Is more than one quinolone needed in clinical practice?

OBJECTIVE: To review clinical information on fluoroquinolone antimicrobials to distinguish between these agents and help define their place in clinica l practice. DATA SOURCES: Primary and review articles on fluoroquinolones available com mercially in the US as of August 2000 were identified through MEDLINE (from 1993-August 2000) and secondary sources. STUDY SELECTION AND DATA EXTRACTION: All pertinent, published, clinical tri als for levofloxacin, moxifloxacin, and gatifloxacin were included. Minimal data were included for quinolones with restricted or limited uses, includi ng trovafloxacin, sparfloxacin, enoxacin, and lomefloxacin. Due to the quan tity of data on ciprofloxacin, only more recent or pivotal trials or articl es summarizing data on specific infections were included. Relevant informat ion was included if it was believed to assist in differentiating between th e fluoroquinolones for infections for which these agents would most commonl y be considered. DATA SYNTHESIS: Fluoroquinolones are a potent class of intravenous and oral broad-spectrum antimicrobial agents used for treating a wide range of comm unity-acquired and nosocomial infections. More than 10 quinolones have been approved for use; although some of these have been withdrawn from the mark et, numerous others are under investigation. it has become increasingly imp ortant to be able to differentiate between these agents. CONCLUSIONS: Differences in safety, antimicrobial spectrum of activity, and resistance development support the selective use of various fluoroquinolon es in differing clinical situations.