New fluoroquinolones: Real and potential roles

The second-generation fluoroquinolones have enjoyed successful clinical use for more than 10 years in many countries, and they have a valued and proven record of safety and efficacy. However, deficiencies with respect to gram-positive and anaerobic organisms limit the use of these agents in respiratory, intra-abdominal, and pelvic infections. New, third-generation agents with dramatically increased activity against gram-positive and anaerobic bacteria—notably, Streptococcus pneumoniae and Bacteroides fragilis—have shown high rates of efficacy in pneumonia, bronchitis, and surgical and gynecologic infections. Although most of these new drugs produce similar clinical results, adverse reaction profiles differ and may influence therapeutic choices.