Sunday June 4, 2006
Quinolones in UTI
Q; Name atleast one quinolone which should not be used for UTI in ICU ?
A: Moxifloxacin (avelox) - as it doesn't reach sufficient level in the urine. On the flip side, the advantage is that you don't need to adjust dose in renal insufficiency unlike other quinolones if use for other reasons. Similarly, Sparfloxacin (Zagam) and trovafloxacin (Trovan - almost off the market due to severe hepatic side effects) should not be used as these 3rd and 4th generation quinolones are more metabolized through liver.
Urinary tract infection (UTI) is a common and many time an isolated or accidental finding in ICU. Rememeber ! Bactrim (TMP/SMX) is still a first line, cost-effective and preferred antibiotic for uncomplicated UTIs. You should jump to quinolone only if your hospital's antibiogram shows local resistance higher than 20% or if patient is allergic to sulfas. Even in this instance nitrofurantoin is a very valid choice. If you decide to use quinolone - ciprofloxacin, ofloxacin, or norfloxacin is a better choice. Levofloxacin is also commonly prescribed but technically it is not really needed for UTI and just contribute to increase resistance in ICU by overuse.
Previous related pearls:
1. Quinolones and errant glycemic reaction
2. Epidemic of new fluoroquinolone induce strain of C. Diff.