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The Utility of Fluoroquinolones in the Critically Ill

Auburn University Harrison School of Pharmacy, UAB School of Medicine Huntsville Regional Medical Campus Division of Internal Medicine, Huntsville, Alabama, wargoka{at}auburn.edu

Brad M. Wright, PharmD

Huntsville Hospital, Huntsville, Alabama

Rahul Gupta, MD, MPH, FACP

Department of Medicine, Meharry Medical College, and the Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, Tennessee

Fluoroquinolone antibiotics have been used for more than 40 years to treat a variety of infections from simple uncomplicated urinary tract infections to infections as severe as nosocomial-acquired pneumonia. Their availability both orally and intravenously, ease of dosing, favorable safety profile, and broad spectrum of activity have led to the pervasive use of these agents in both the community and institutions. Unfortunately, this widespread use has led to the development of resistance and subsequently, increased mortality. Resistance, specifically with Pseudomonas aeruginosa and Escherichia coli, as well as their association with the development of Clostridium difficile–associated diarrhea, has led many clinicians to question the use of fluoroquinolones in the critically ill. This article will review these issues related to the use of fluoroquinolones, in an effort to better define their role among institutionalized patients.

Key Words: fluoroquinolones • resistance • Pseudomonas aeruginosa • Escherichia coli • Clostridium difficile

This version was published on October 1, 2008

Journal of Pharmacy Practice, Vol. 21, No. 5, 346-355 (2008)
DOI: 10.1177/0897190008318502


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