Professor Zhao Xiaodong

Chief physician and Department Director

Emergency Department of The First Affiliated Hospital of PLA General Hospital of China (Hospital 304)

Q1: What kind of infections do you encounter in the emergency department that are treated with quinolones?

A1: The most commonly infection treated with quinolones in emergency care is community-acquired pneumonia (CAP). At present, the proportion of non-specific infections in CAP is very high, and many of them are caused by atypical pathogenic agents such as mycoplasma pneumoniae, chlamydia pneumoniae and legionella pneumophila. Therefore, in the initial treatment of such infectious diseases, quinolones and other broad-spectrum antibacterial drugs which have killing effects on both common pathogenic bacteria and atypical pathogenic agents, are usually used to control the symptoms of infection quickly.

Q2: Why do these diseases prefer quinolones as the first choice antibiotic?

A2: The application of quinolones treating these diseases has the following advantages; 1. Once a day and easy to use, patient compliance is good; 2. Wide antibacterial spectrum, effective for both common pathogenic bacteria and other atypical pathogenic agents such as mycoplasma; 3. The infectious pathogens of the diseases are complex and the drug resistance situation is serious. Quinolones are more suitable for the situation in China. Therefore, quinolones are preferred as the first choice in emergency infectious diseases.

Q3: What do you need to pay attention before using quinolones?

A3: Before the application of such drugs, it should be noted that detailed medical history should be asked. It should avoid drug interactions and serious adverse reactions; 1. If quinolones are used together with oral antidiabetic agents, hypoglycaemia or hyperglycaemia may occur. Blood glucose monitoring should be strengthened when they are used together; 2. If quinolones are used together with I-A or class III anti-arrhythmic drug, it may increase the risk of lengthening Q-T duration and even cause fatal arrhythmia when serious. Combination therapy should be avoided as much as possible; 3. Some quinolones may have central nervous system toxicity. Therefore, patients with epilepsy or previous central nervous system diseases should use it with caution.¹ Now, an article published in the Journal of the American College of Cardiology (JACC) shows that quinolones increase the risk of aorta dissection,² which is causing a stir in the medical field. However, the result of this study is not necessarily accurate. For example, the application of quinolones antibacterial drugs in the breeding process of poultry and aquatic products resulted in the accumulation of drugs in the food chain; or the artificially application of many statistical methods to exclude the influence of various factors in the experimental design may cause the deviation of experimental results. Therefore, in the actual application, we should choose therapeutic drugs according to the specific situation of patients, closely monitor the adverse reactions in drug treatment and timely adjust the treatment regimen.

Q4: What do you think about sequential therapy in terms of drug and patient characteristics?

A4: Sequential treatment refers to the method of rapid control of infection by intravenous drip first, and then oral treatment after clinical symptoms improved. According to the data of bacterial resistance in regions and hospitals, targeted selection of antibacterial drugs can indeed make more accurate application of antibiotic drugs and reduce drug resistance.³ However, because the detection of pathogen takes a certain time and some pathogens are complicated; the detection results may not be accurate. Therefore, for patients with emergency infections, we usually empirically use broad-spectrum antibacterial agents, such as quinolones at first. For patients in critical condition, we use intravenous infusion of quinolones to quickly control the infection. While for less severe patients, we use oral administration and change antibiotics or adjust doses according to the progression of the disease, which is the basic principle of our medication.

Q5: How satisfied are you with the clinical efficacy of quinolones?

A5: At present, in clinical practice, quinolones have a broad-spectrum coverage of pathogens, good anti-infection effect and low drug resistance rate for CAP patients.  The overall efficacy is quite satisfactory.

References

1. Infection group, Chinese respiratory association. Expert consensus on rational use of quinolones in the treatment of lower respiratory tract infections [J]. Chinese Journal of Tuberculosis and Respiratory 2009;32:646-654.
2. Lee CC, et al. J Am Coll Cardiol 2018;72:1369-1378.
3. Li hui, et al. Medical Review 2008;14:1387-1389.