Active substances: Ciprofloxacin
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Sherman Silber of the Infertility Center of St. It should be taken two hours before or six hours after these products. CYP 1 A 2 substrates that exhibit increased serum levels in ciprofloxacin-treated patients include tizanidine, theophylline, caffeine, methylxanthines, clozapine, olanzapine, and ropinirole.
Use of ciprofloxacin is cautioned in patients on theophylline due to its narrow therapeutic index.
Quinolones are considered bactericidal agents, as minimum bactericidal concentrations MBCs are typically no more than one to two serial dilution steps higher than MICs.
These older quinolones are also inactive against anaerobic bacteria. The newer agents such as gatifloxacin, moxifloxacin, and gemifloxacin demonstrate even greater activity against Gram-positive and atypical organisms compared to levofloxacin.
High susceptibility rates 99. Jones et al.
Gram-Positive Organisms The older generations of fluoroquinolones such as ciprofloxacin have moderate activity against Gram-positive organisms; however, the clinical utilization of these agents as monotherapy is typically avoided for treatment of Gram-positive infections due to the potential for rapid development of resistance.
In comparison, the newer fluoroquinolones have demonstrated improved activity against Gram-positive organisms and are often used to treat for a wide-range of infections caused by these microorganisms.
The newer fluoroquinolones exhibit favorable activity against most clinical isolates of streptococci Table 1.
The activity of fluoroquinolones against enterococcal species is variable to poor. Anaerobic Organisms Anaerobic activity with the fluoroquinolones has evolved with advancement of these agents. Fluoroquinolones such as ciprofloxacin and levofloxacin have minimal activity against anaerobes.
Both trovafloxacin and clinafloxacin exhibit improved anti-anaerobic activity compared to the older compounds 115, 136. In fact, trovafloxacin received FDA indications for various anaerobic infections including complicated intra-abdominal infections, gynecologic and pelvic infections, and complicated skin and skin structure infections, including diabetic foot infections.
However, toxicities associated with these agents have halted the clinical usage. Gatifloxacin, moxifloxacin, and gemifloxacin exhibit variable activity against anaerobes particularly against Gram-negative anaerobes 92, 115, 136.
In general, the newer fluoroquinolones have greater activity against Gram-positive versus Gram-negative anaerobes. Mycobacteria The fluoroquinolones have variable activity against mycobacteria. Fluoroquinolone activity varies against species of non-tuberculosis mycobacteria; the trend of increased activity of the C-8 methoxy-fluoroquinolones continues against these isolates 90, 91, 259, 260.
Other investigators reported the range of moxifloxacin MICs between 0. Gatifloxacin, moxifloxacin, and gemifloxacin have lower MICs ranges than levofloxacin and ciprofloxacin against these organisms 102, 128. The preferred way to express these relationships is to define the interaction of a pharmacokinetic parameter such as area under the curve AUC or peak concentration and an index of organism susceptibility such as MIC 232.
Fluoroquinolones kill bacteria in a concentration-dependent fashion.