The role of quinolones in upper respiratory tract infections

Fluoroquinolones are widely used in clinical practice because of their advanced pharmacokinetic properties, potential activity against most bacterial species, excellent clinical responses, and few side effects. Quinolones have no role in the treatment of pharyngitis or simple otitis media. Until recently, the available fluoroquinolones were not indicated for the treatment of acute purulent sinusitis because of their perceived inactivity against Streptococcus pneumoniae. Although not generally considered to be drugs of first choice, older quinolones have efficacy similar to that of cephalosporins and β-lactams in randomized clinical trials. Well-conducted clinical trials have shown that the new fluoroquinolones are as effective as standard comparators in patients with suspected or proven acute bacterial sinusitis and may allow shorter treatment. Ciprofloxacin remains the fluoroquinolone of choice for chronic otitis media and malignant otitis media. The new “respiratory“ fluoroquinolones have microbiologic and pharmacokinetic advantages over the older agents. Clinical trials have confirmed clinical activity, but superiority compared with older agents has not been conclusively shown. Trials devised to demonstrate clinical or pharmacoeconomic benefits are still required.