1. Ariana Hurtado Garcia Medico Interno

7. The fluoroquinolones act by inhibiting type 2 bacterial DNA topoisomerases, DNA gyrase and topoisomerase IV. They bind to and trapp the enzyme-DNA complex. This blocks DNA synthesis and cell growth and ultimately has a lethal effect on the cell.

14. M, Metabolized; R, renal excretion as unchanged drug. Agent Administration Absorption Half-Life (hrs) Disposition Norfloxacin Oral 50% 4 (8 in anuria) M (20%) R (27%) Ciprofloxacin Oral, IV 75% 4 (10 in anuria) R (50%) M Levofloxacin Oral, IV 98% 7 R (80%) Gatifloxacin Oral, IV 96% 7-8 R (70%) Moxifloxacin Oral, IV 89% 10-14 R (20%) M (25%) (in liver) Nitrofurantoin Oral Adequate 0.6-1.2 R, M (in tissue) Polymyxin B Topical, oral, IV Not absorbed in adults; absorbed in children 6 by IV R

16. Disease Recommendations RESPIRATORY TRACT INFECTIONS Pharyngitis, otitis media Not appropriate Necrotizing otitis Ciprofloxacin for Pseudomonas aeruginosa Sinusitis Third-generation fluoroquinolone Community-acquired pneumonia Third-generation fluoroquinolone Hospital-acquired pneumonia Ciprofloxacin, for susceptible gram-negative pathogens URINARY TRACT INFECTIONS Cystitis, uncomplicated All effective (second generation most appropriate) Pyelonephritis All effective (second generation most appropriate) Prostatitis All effective SKIN STRUCTURE INFECTIONS Primary cellulitis Not appropriate as first line therapy Anaerobic soft-tissue infections Not appropriate

17. Disease Recommendations OSTEOMYELITIS Gram-negative bacterial infections Ciprofloxacin BACTERIAL DIARRHEAL DISEASES Ciprofloxacin used most commonly; all considered likely to be effective SEXUALLY TRANSMITTED DISEASES Gonorrhea Resistance testing required Chlamydia Ofloxacin, levofloxacin Chancroid All likely to be effective Mycoplasma Ofloxacin, levofloxacin Syphilis Not appropriate MYCOBACTERIAL DISEASES Disseminated M. avium complex Ciprofloxacin, ofloxacin as fourth agent if needed M. tuberculosis Ofloxacin, levofloxacin for drug-resistance or intolerance to first-line agents

22. Quinolonas disponibles en nuestro medio : - Acido nalidíxico: tabletas de 500 mg y susp. 250mg/5ml. 1gr c/6h VO (Acido Nalidixico y Wintomylon) - Acido pipemídico: comprimidos de 200 y 400 mg -Ciprofloxacino: comprimidos de 250, 500, 750 mg. ampollas de uso i.v de 100, 200 y 400 mg. 500-750mg c/12h VO 200-400mg c/12h IV (Cilaxon, Cigram,Cifloxin, Cipro, Cipro XR, Ciprofloxacina, Quinoprón)

23. -Levofloxacino: comprimidos de 250, 500 mg y frasco-ampollas de uso i.v de 500 mg. 500mg VO o IV c/24h (Levaquin, Levovax, Respilox, Tavanic) - Norfloxacino: comprimidos de 400 mg. 400mg c/12h VO (Ambigram, Nefrixine, Noprose, Norfloxacino, Senro, Urigen, Zoronix) - Pefloxacino: comprimidos y ampollas de uso IV 400 mg. -Moxifloxacino: comprimidos de 400 mg