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Quinolones. A group of synthetic, bactericidal antibacterial agents Basic chemical structure of Quinolones. Essential for antibacterial activity. Substitution with fluoride to get fluoroquinolone. Addition of Piperazine ring in Ciprofloxacin and enrofloxacin.
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Quinolones A group of synthetic, bactericidal antibacterial agents Basic chemical structure of Quinolones
Essential for antibacterial activity Substitution with fluoride to get fluoroquinolone Addition of Piperazine ring in Ciprofloxacin and enrofloxacin Substitution with oxygen atom Improves activity against anaerobes Change to a carbon from a nitrogen decreases some adverse CNS effects
Properties • Amphoteric compounds and exist as zwitter ions at physiological PH • Exhibit poor water solubility • Form needle shaped crystals in concentrated urine
ClassificationBased upon their evolution pattern (chronology) 1st generation Quinolones: Nalidixic acid Oxolinic acid Flumequine 2nd generation Quinolones (1st generation Fluoroquinolones): Ofloxacin Norfloxacin
Classification Enrofloxacin Ciprofloxacin 3rd generation quinolones (2nd generation Fluoroquinolones): Levofloxacin Gatifloxacin
Mechanism of action Interference with the action of DNA-gyrase (Topoisomerase-II) enzyme Reduction in the supercoiling occurs with consequent disruption of DNA replication Degradation of DNA into small fragments by the action of exonucleases
Bacterial resistance • Alteration in bacterial DNA-gyrase enzyme with a decreased affinity for Quinolones • Reduced permeability of bacterial membranes to Quinolones
Pharmacokinetics Good rate and extent of absorption after oral administration in monogastric animals and pre-ruminating calves Mg+2 and Ca+2 ions decrease the absorption of Quinolones after oral administration
Pharmacokinetics Distribute well into all body tissues and fluids including CNS, bones and prostrate Also get accumulated in macrophages and leucocytes Enrofloxacin undergoes de-ethylation to form Ciprofloxacin
Pharmacokinetics Renal excretion is the major route of elimination Alkaline urine increases their re-absorption Fluoroquinolones appear in the milk of lactating animals in high concentration
Antimicrobial spectrum 1st generation Quinolones: • Extended gram negative spectrum 1st generation Fluoroquinolones: • Broader spectrum • Effective against a wide range of gram negative & gram positive bacteria, Mycoplasma & Chlamydia • Ineffective against streptococcus & anaerobes
Antimicrobial spectrum 2nd generation Fluoroquinolones: • More broader than 1st generation Fluoroquinolones • Also effective against streptococcus & anaerobes • Concentration dependent antibacterial activity • Significant post-antibiotic effect
Clinical applications Older Quinolones: primarily used as urinary antiseptics Fluoroquinolones: used against intra-cellular pathogens treatment of deep-seated infections meningo-encephalitis, osteomyelitis & arthritis
Clinical applications Oxolinic acid: Treatment of bacterial diseases of fish Enrofloxacin: respiratory infections such as Mycoplasmosis and Pasteurellosis
Clinical applications Flumequine: Treatment of gram negative enteric infections (such as Colibacillosis) in poultry and livestock Ciprofloxacin: Treatment of typhoid in humans
Adverse effects 1. Chondrodestruction: • Chelation of Mg+2 in cartilages • Chondrodestruction & joint growth • Disorders • Affects growing animals, particularly dogs & foals
Adverse effects 2. Seizures: Fluoroquinolones can lower the threshold to seizures 3. crystalluria: Can cause crystalluria in dogs due to their low solubility in acidic urine
Contraindications • Growing dogs under 12 to 18 months of age • Patients suffering from seizure disorders • Patients with renal insufficiency • Lactating animals
Drug interactions • Mg+2, Ca+2, Al+3 & non-systemic antacids • Fluorinated Quinolones with NSAIDS • Quinolones with β-lactams • Quinolones with Aminoglycosides • Quinolones with Clindamycin • Quinolones with Metronidazole