Abstract
Quinolone chemotherapeutics have been used to treat urinary tract infections since the 1960's. Over the last 25 years, their systemic derivatives, collectively called fluoroquinolones, have been introduced into clinical use.
Current fluoroquinolones can be characterized as bactericidal preparations with a broad antimicrobial spectrum, high oral bioavailability, long half-life and good tolerability. Contraindications for use up to 18 years of age, as well as during pregnancy and lactation, apply to all quinolones due to the as yet unclear effects on the developing musculoskeletal system of children, or other side effects.
Due to their advantageous pharmacokinetic and pharmacodynamic properties and the overall low number of side effects in adults, fluoroquinolones are among the popular preparations used to treat infections of various kinds. The increase in fluoroquinolone consumption in the hospital and community setting has been followed by a rapid rise and spread of microbial resistance. all representatives.
Therefore, fluoroquinolones lose their status as an effective drug for the initial treatment of most infections. In the Czech Republic, resistance to ciprofloxacin in invasive Escherichia coli strains increased over five years from 8% in 2001 to 20% during 2005 (see EARSS, http://www.szu.cz/cem/).
An even faster increase in the frequency of resistance was observed in Klebsiella pneumoniae and Pseudomonas aeruginosa species, where after the initial good efficacy, one third and one half of the invasive strains are currently resistant to fluoroquinolones, respectively. Almost all strains of MRSA (methicillin-resistant Staphylococcus aureus) are resistant to fluoroquinolones in our country.
Resistance to this group of drugs, but also the incidence of MRSA, is lower in hospitals where uncompromising restriction of unnecessary fluoroquinolone applications is introduced than in hospitals where fluoroquinolones are used without restriction. Further degradation of fluoroquinolones by resistance can be averted only by specifying their indications.
Therefore, the Working Group for Antibiotic Policy at the Presidium of the Czech Medical Society JEP (ČLS JEP) presents the "Consensus on the Use of Antibiotics III. Quinolones", a document focused on the rational use of this group of antibiotics.
This document was prepared in the same way as the previous two (Consensus on the Use of Antibiotics I-Penicillin Antibiotics, and Consensus on the Use of Antibiotics II-Macrolides and Azalides) and opposed by members of the Czech Medical Society JEP. The aim is to reduce the epidemiological risk of the development and rise of resistance to fluoroquinolones.