Since the introduction of ciprofloxacin in 1987, fluoroquinolones have
expanded far beyond their early role in the treatment of urinary tract
infections. Clinical applications beyond genitourinary tract infections
include upper and lower respiratory infections, gastrointestinal
infections, gynecologic infec- tions, sexually transmitted diseases, and
some skin and soft tissue infections. Their ease of administration,
favorable pharmacokinetic properties, excellent tolerability, and
efficacy give them enormous potential for use and misuse alike.
Quinolones have few common adverse effects, most notably nausea,
headache and dizziness. Less frequent but more serious adverse events
include prolongation of the corrected QT interval, phototoxicity, liver
enzyme abnor- malities, arthropathy, and cartilage and tendon
abnormalities. While possess- ing many of the favorable properties of
intravenous agents, most fluoro- quinolones offer the convenience of
oral administration, thus contributing to decreased health-care costs
through increased outpatient therapy and short- ened hospital stays.
With the recent introduction of agents such as gatifloxacin and
moxifloxacin, the traditional Gram-negative coverage of fluoroquinolones
has been expanded to include Gram-positive organisms, most importantly
Streptococcus pneumoniae.