It continues to be debatable as to whether or not the effectiveness of fluoroquinolones for the treatment of respiratory disorders is similar to other antibiotic classes.
Fluoroquinolone use for pneumonia is increasing and with it so is bacterial resistance to fluoroquinolones. The majority of the prescribing of fluoroquinolones is inappropriate with less than 4 percent of people prescribed quinolones being appropriate according to clinical guidelines. Clinical guidelines in Canada only recommend fluoroquinolones for outpatient treatment of pneumonia in a small number of patients such as those with certain co-morbid conditions such as patients with a history of COPD, or recent use of antibiotics.
For severe forms of community-acquired pneumonia the fluoroquinolones are associated with improved treatment rates, but with no differences found in mortality between other antibiotic classes.
Fluoroquinolones are not recommended as first line antibiotics for acute sinusitis as this condition is usually self-limiting and the risks outweigh the benefits in comparison to other antibiotic classes.
Antibiotics including fluoroquinolones can be effective in some cases of bronchitis. However, only about 5-10% of bronchitis cases are caused by a bacterial infection; most cases of bronchitis are caused by a viral infection and are self-limiting and resolve themselves in a few weeks. It has been recommended that antibiotics are limited in most cases to those whose symptoms fail to resolve on their own.
Fluoroquinolones are often used for genitourinary infections; in general they are recommended only after other antibiotic regimes have failed. However, for serious acute cases of pyelonephritis or bacterial prostatitis where the patient may need to be hospitalised fluoroquinolones are recommended as first line therapy.
Prostatitis has been termed "the waste basket of clinical ignorance" by prominent Stanford University Urologist Dr. Thomas Stamey. Campbell's Urology, the urologist's most authoritative reference text, identifies only about 5% of all patients with prostatitis as having bacterial prostatitis which can be "cured" at least in the short term by antibiotics. In other words, 95% of men with prostatitis have little hope for a cure with antibiotics alone since they don't actually have any identifiable bacterial infection.
The American Thoracic Society recommends that fluoroquinolones are not used as a first line agent, instead recommending macrolide or doxycycline as first line agents. The Drug-Resistant Streptococcus pneumoniae Working Group recommends fluoroquinolones are only used after other antibiotic classes have been tried and failed or in those with demonstrated drug-resistant Streptococcus pneumoniae. The Center for Disease Control are concerned that fluoroquinolones are being used as a "one-size-fits-all" treatment unnecessarily by doctors without considering suitability and differences due to age and other risk factors. Effective interventions have been recommended to reduce the excessive fluoroquinolone prescribing in the United States.
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