Objective: This paper demonstrated the effectiveness of intrastromal injection of levofloxacin 1.5% ophthalmic solution in the management of recalcitrant Gram-positive bacterial keratitis. Methods: This is a report on two cases of recalcitrant bacterial keratitis encountered at the External Diseases and Cornea Clinic of the Department of Ophthalmology and Visual Sciences at the Philippine General Hospital. Results: Two middle-aged females presented with bacterial keratitis unresponsive to previous antibiotic treatment with impending corneal perforation. The Gram stain of the corneal scraping in the first case revealed Gram-positive cocci, while the second case showed encapsulated Gram-positive bacilli and encapsulated Grampositive cocci in chains. In both cases, repeated intrastromal injections of levofloxacin 1.5% in addition to increasing the frequency of topical levofloxacin 1.5% resulted in marked improvement in visual acuity and resolution of deep stromal infiltrates and hypopyon. Conclusion These cases highlighted the utility of intrastromal levofloxacin 1.5% ophthalmic solution in the management of recalcitrant Gram-positive bacterial keratitis.
Fluoroquinolones ; Levofloxacin

Purpose: This study compared the safety outcomes of two intracameral fluoroquinolone antibiotics, moxifloxacin and levofloxacin, as prophylaxis treatment in eyes that underwent uncomplicated cataract surgery. Methods: This is a prospective, double-masked, randomized, interventional, single-center clinical trial. Eyes with visually-significant cataracts underwent phacoemulsification and received preservative-free intracameral 0.5% moxifloxacin [58 eyes (M group)] or 0.5% levofloxacin [56 eyes (L group)] at the end of the surgery as antibiotic prophylaxis. The following safety parameters were evaluated postoperatively at Day 1, Week 1 and Month 1: central retinal thickness (CRT), macular volume (MV), central corneal thickness (CCT), and endothelial cell density (ECD). In-between group comparison was made at each of the 4 study visits using Student’s t-test. Results: Both M and L groups had similar baseline characteristics. There were no significant differences in CRT, MV, CCT and ECD between the 2 groups at each time point in the study. There were no significant differences in the mean changes in CRT, MV, CCT and ECD from baseline to final visit between the 2 groups. No study-related adverse events were observed during the study period. Conclusion Intracameral application of preservative-free 0.5% moxifloxacin and 0.5% levofloxacin appear to have similar safety outcomes when used as antibacterial prophylaxis among eyes undergoing cataract surgery. Based on the results, both fluoroquinolone agents are potentially suitable options for endophthalmitis chemoprophylaxis.
Levofloxacin ; Moxifloxacin ; Fluoroquinolones

BACKGROUND: Nadifloxacin is a synthetic fluoroquinolone with a broad spectrum. It has been suggested to not only have antibacterial, but also anti-inflammatory actions. In addition, it is effective against antibiotic-resistant Propionibacterium acne. Upon review of the literature, however, no studies have been performed concerning the efficacy and safety in terms of irritation potential and skin barrier changes after applying nadifloxacin. OBJECTIVE: This study intended to evaluate the skin irritation and changes of the skin barrier function associated with the administration of nadifloxacin 1% cream for the treatment of acne vulgaris. Furthermore, the efficacy and safety of nadifloxacin 1% cream were also assessed. METHODS: The changes in the lesion counts, Korean Acne Grading System (KAGS) and adverse events were recorded. The biophysical profiles of the skin, including transepidermal water loss (TEWL), skin surface hydration and redness were measured by Tewameter(R), Corneometer(R) and Mexameter(R) for 3 weeks. RESULTS: At the end of the therapy, 69% of inflammatory lesions (p<0.0001) and 27% of noninflammatory lesions (p=0.26) resulting from acne were decreased from the baseline. Adverse events were reported in two patients, but they were transient and tolerable. The skin barrier function showed no changes during the treatment periods. CONCLUSION: Nadifloxacin 1% cream is effective for the treatment of acne vulgaris without the changes of skin barrier function.
Acne Vulgaris ; Fluoroquinolones ; Humans ; Propionibacterium ; Quinolizines ; Skin

BACKGROUND: A high prevalence of fluoroquinolone resistance among uropathogens has been observed in Korea. Since empirical antimicrobial therapy should be guided by the proportion of pathogens resistant to the chosen antibiotic, the limitation of fluoroquinolones as the first empirical choice for acute cystitis is noticed in the clinical setting. The present study was undertaken to determine the susceptibility profiles of urinary isolates to cefcapene pivoxil and assess the clinical efficacy in patients with acute uncomplicated cystitis. MATERIALS AND METHODS: The study was a prospective, open label, non-comparative, non-blinded trial. Ninety-two patients with acute, uncomplicated symptomatic cystitis from two hospitals were treated with cefcapene pivoxil 100 mg tid for 5 days and followed up for 2 weeks. RESULTS: Seventy-seven of the 92 patients were evaluated. Bacteriological eradication of initial pathogens was achieved in 97.4% by 2 weeks after therapy termination. Seventy-four of 77 (96.1%) patients were symptomatically cured or improved after completion of therapy. Drug related adverse experiences were seen in 8 patients. None necessitated cessation of therapy. No significant biochemical or hematological abnormalities occurred. CONCLUSION: These results demonstrate the clinical efficacy and safety of empirical 5-day cefcapene pivoxil for acute uncomplicated cystitis.
Cystitis ; Fluoroquinolones ; Humans ; Korea ; Prevalence ; Prospective Studies

Resistance of uropathogenic E. coli to trimethoprim/sulfamethoxazole in Korea has surpassed the threshold of 20% at which the drug is no longer recommended for empirical treatment and routine urine culture is recommended. Given the unavailability of alternative agents other than fluoroquinolones, increased use of this agent, which is known to cause collateral damage, appears inevitable. However, the majority of study data have been reported from studies of pyelonephritis, and seldom represent the level of resistance of community acquired uncomplicated cystitis. For selection of a rational empirical agent according to the guidelines, judicious interpretation of recent studies conducted in Korea with regard to quality of the evidence is required.
Cystitis ; Drug Resistance ; Fluoroquinolones ; Korea ; Pyelonephritis

BACKGROUND: A high prevalence of fluoroquinolone resistance among uropathogens has been observed in Korea. Since empirical antimicrobial therapy should be guided by the proportion of pathogens resistant to the chosen antibiotic, the limitation of fluoroquinolones as the first empirical choice for acute cystitis is noticed in the clinical setting. The present study was undertaken to determine the susceptibility profiles of urinary isolates to cefcapene pivoxil and assess the clinical efficacy in patients with acute uncomplicated cystitis. MATERIALS AND METHODS: The study was a prospective, open label, non-comparative, non-blinded trial. Ninety-two patients with acute, uncomplicated symptomatic cystitis from two hospitals were treated with cefcapene pivoxil 100 mg tid for 5 days and followed up for 2 weeks. RESULTS: Seventy-seven of the 92 patients were evaluated. Bacteriological eradication of initial pathogens was achieved in 97.4% by 2 weeks after therapy termination. Seventy-four of 77 (96.1%) patients were symptomatically cured or improved after completion of therapy. Drug related adverse experiences were seen in 8 patients. None necessitated cessation of therapy. No significant biochemical or hematological abnormalities occurred. CONCLUSION: These results demonstrate the clinical efficacy and safety of empirical 5-day cefcapene pivoxil for acute uncomplicated cystitis.
Cystitis ; Fluoroquinolones ; Humans ; Korea ; Prevalence ; Prospective Studies

BACKGROUND: Antimicrobials have been a mainstay of inflammatory acne treatment for more than 30 years. However, antibiotic-resistant propionibacteria had been isolated with increased frequency, and associated with failure to respond to antibiotic therapy. OBJECTIVE: The aim of this study was to investigate the clinical efficacy and tolerance of 1% nadifloxacin cream. METHODS: In the final analysis, 197 patients with mild to moderate facial acne vulgaris were enrolled. The patients were instructed to apply 1% nadifloxacin cream twice daily to the affected skin after washing the face. Following 2 and 4 weeks of treatment, patients were observed for clinical response: number of the acne lesions, Korea acne grading system (KAGS), global improvement, and occurrence of adverse reactions. RESULTS: During 4 weeks of treatment, nadifloxacin caused significant reduction in the number of inflamed papulo-pustular lesions and open/closed comedones. In addition, significant reduction of KAGS was observed. About 96% of patients showed clinical improvement in the overall evaluation of the therapeutic effect by physicians. All reported adverse events were mild. CONCLUSION: This study shows that 1% nadifloxacin cream can be an effective and safe treatment for mild to moderate acne vulgaris.
Acne Vulgaris ; Fluoroquinolones ; Humans ; Korea ; Quinolizines ; Republic of Korea ; Skin

Fluoroquinolones are antimicrobial agents that have a broad range of activity against both gram-negative and gram-positive organisms. Anaphylactoid reactions have been sporadically reported with fluoroquinolones. There have been a few reports that describes cross-reactivity between fluoroquinolones. We experienced a case of ofloxacin-induced anaphylactoid reaction, and confirmed cross-reactivity between ofloxacin and ciprofloxacin with the oral challenge test. Cross-reactivity between fluoroquinolones may be important, and avoidance of any fluoroquinolones should be mandatory for patients with hypersensitivity reaction to one of these drugs.
Anti-Infective Agents ; Ciprofloxacin ; Fluoroquinolones* ; Humans ; Hypersensitivity ; Ofloxacin*

Torsades de pointes associated with a prolonged QT interval is a life-threatening arrhythmia, which may be induced by any of the following: drugs, electrolyte imbalances, severe bradycardia and intracranial hemorrhage. Torsades de pointes is characterized by beat-to-beat variations in the QRS complexes in any ECG leads with rates of 200~250 per minute. Fluoroquinolones are widely used and well tolerated antibacterial agents. However, prolongation of the QT interval leads rarely to Torsades de pointes as a significant adverse effect. So, it should be used with caution in high-risk patients for developing Torsades de pointes. We report one case of 67-year old man with contact burns who experienced Torsades de pointes, which probably resulted from the use of levofloxacin, and no further episode occurred after its withdrawal.
Anti-Bacterial Agents ; Arrhythmias, Cardiac ; Bradycardia ; Burns ; Electrocardiography ; Fluoroquinolones ; Humans ; Intracranial Hemorrhages ; Ofloxacin ; Torsades de Pointes

BACKGROUND: Fluoroquinolones (FQs) are important drugs for treating multidrug-resistant tuberculosis (MDR-TB). However, due to widespread use of FQs, the resistance rates to FQs have been increasing among Mycobacterium tuberculosis. Rapid and reliable FQ drug susceptibility testing (DST) is crucial for successful treatment of MDR-TB. In this study, the feasibility of molecular detection of FQ resistance was evaluated. METHODS: A total of 95 MDR-TB isolates were collected from Jan through Oct 2009 at the Korean Institute of Tuberculosis. DST for ofloxacin (OFL), levofloxacin, and moxifloxacin was performed using the Lowenstein-Jensen media absolute concentration method. Minimum inhibitory concentrations (MIC) of these were determined using the broth microdilution method. DNA was extracted from cultured isolates using bead beating method. The quinolone resistance-determining region (QRDR) of gyrA and gyrB were amplified and those sequences were analyzed. RESULTS: Of 95 isolates, 79 were resistant to at least one of FQs. Of these, 71 (89.9%) harbored mutation in the QRDR of gyrA or gyrB. None of FQ susceptible strains possessed any mutation in gyrA or gyrB. Mutations in codon 94 of gyrA were most common; only two isolates had mutation in only the gyrB gene. OFL MICs for isolates with gyrA mutation ranged from 1 to 32 microg/mL, but FQ susceptible isolates showed MICs ranging from < or =0.06 to 0.5 microg/mL. CONCLUSION: Mutation analysis of QRDR of gyrA and gyrB showed 89.9% sensitivity and 100% specificity for detecting FQ resistance in MDR-TB. Therefore, molecular DST can be useful for rapid detection of FQ resistance in MDR-TB.
Codon ; DNA ; Fluoroquinolones ; Levofloxacin ; Microbial Sensitivity Tests ; Mycobacterium tuberculosis* ; Ofloxacin ; Tuberculosis ; Tuberculosis, Multidrug-Resistant