Quinolones - Qulnolone antibiotics are typically employed to treat CALRTIs, such as CAP and AECB, but are sometimes used to treat acute bacterial sinusitis. The quinolones of choice in the outpatient setting are those with an enhanced S. pneumoniae activity like that of levofloxacin. The efficacy, success rates and safety of quinolones e.g., ciprofloxacin, levofloxacin, moxifloxacin, gatifloxacin 10 and trovafloxacin, in clinical studies for CAP and AECB have been recently summarized (10,81). Comprehensive reviews of quinolone clinical utility, pharmacokinetics, adverse effects and microbiology have been published (82-84). A recent review covering the most commonly prescribed fluoroquinolones examines the mechanisms which lead to adverse side effects, such as cardiotoxicity, phototoxicity and CNS effects (85). Because of their target of action, resistance toward fluoroquinolones are primarily due to mutations in gyr A and parC, although efflux may also play an important role in quinolone resistance. For resistant S. aureus and S. pneumoniae, it has been shown that inhibiting the NorA quinolone pump renders both strains susceptible to quinolones again (19).
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