Q16. According to the IDSA guidelines, what is the role of fluoroquinolones? Could you also compare the use of levofloxacin with that of ciprofloxacin?
Summary: The 2010 IDSA guidelines recommend using empiric fluoroquinolones when treating low-risk febrile neutropenic patients. When developing the guidelines it was found that the most commonly studied fluoroquinolone in this situation was ciprofloxacin, administered in combination with amoxicillin-clavulanate. Due to ciprofloxacin’s lack of activity against Gram-positive bacteria, monotherapy with ciprofloxacin was not recommended. However, levofloxacin, which does have both Gram-positive and Gram-negative coverage has the potential to be given as monotherapy in low-risk febrile neutropenic patients. The guidelines also note that fluoroquinolones can be used in high-risk patients who have started to recover following administration of parenteral broad-spectrum antibiotics. In these patients, treatment can be switched to the orally administered fluoroquinolone if the culture confirms susceptibility to these agents.