Enoxacin. Ofloxacin. Levofloxacin.

Enoxacin or Penetrex has lots of drug interactions. So probably this may, as it implies, penetrate, but if it’s got lots of drug interactions, this probably isn’t one of the better products to recommend.

Ofloxacin or Floxin is a pretty good drug. It is basically as good for most indications as ciprofloxacin including things like chlamydia and gonorrhea. It should be given between meals. It can be useful in pelvic inflammatory disease.

Sparfloxacin is Zagam. This is given once a day. It is especially good against pneumococci. However, this product has photosensitivity problems. Even with the sunscreen we’re seeing people who develop photosensitivity so I think that probably you’re not going to find a lot of clinicians using this drug, at least for very long.

Levofloxacin is Levaquin, again, given once a day. Again, good against pneumococci. It may be useful in respiratory infections and basically this is just a stereoisomer of ofloxacin.

Grepafloxacin. This is Raxar. Again, given once a day. It may be useful in community acquired pneumonias. It looks like this is going to be a good drug against penicillin resistant pneumococci but there is not a lot of data about this drug at this particular point.

Since I put the handout together, there has been another fluoroquinolone introduced and that is not on your handout. This is trovafloxacin. The trade name is Trovan. It also comes in an IV form. Again, this is given once a day. In fact, from preliminary data it looks as though this drug may be the most effective of all of the fluoroquinolones in terms of in vitro coverage including anaerobes. So here is a drug that we have that has reasonable pneumococcal coverage and also some anaerobic coverage. What I would suggest for the time being is to limit its use to mixed infections where anaerobes are likely to be present.

Its cost is comparable to other oral fluoroquinolones. Dizziness is a problem with this drug in about 10% of patients. They found that giving it at bedtime or with food for some reason cuts down on the dizziness. Unlike sparfloxacin, this drug does not seem to have much of a problem with photosensitivity reactions. So that’s a new one. If you haven’t seen it yet, I’m sure that they will be bringing samples by any day now.

Incidentally I would comment very quickly about samples. Be careful of those things. Those can lead to some dangerous prescribing practices. When they bring them in, ask them how much they are. Ask them how much a 10 day or 5 day or whatever a normal course is or call your pharmacy and find out. If it does not represent a significant advantage over something that you already have that’s cheaper, stick with prescribing the cheaper drug and reserve those samples for the people who really need them.

Unfortunately, many people treat samples like they were not prescription drugs. They’re to be handed out to the neighbors, you take only a few of them and you keep them around forever. You don’t pay any attention to the expiration date and I think we’ve got a lot of unrecognized toxicity out there because of all of the samples of antibiotics that we have floating around. Certainly I think it contributes to the problem of resistance development that we have out there.

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