Integrating Fluoroquinolones into the Hospital Formulary

Joseph S. Bertino, Jr., Pharm.D.


Pharmacotherapy. 2001;21(10s) 

In This Article

Abstract and Introduction

With the increasing availability of new agents, selection of fluoroquinolones for formulary inclusion can be difficult. Appropriate evaluation of the important characteristics (pharmacokinetic and pharmacodynamic properties, antimicrobial activity, efficacy, tolerability, cost) of these agents should allow selection of the most cost-effective ones. Evidence from in vitro studies and clinical trials indicates differences exist among fluoroquinolones, especially in terms of activity against gram-positive, aerobic organisms. For selected clinical situations, it may be important to choose an agent that is available in both intravenous and oral formulations. Comparative drug costs, as well as costs associated with potential clinical failure and adverse events, should be evaluated carefully. Dosage regimens should be considered, as shorter durations of therapy and less frequent dose administration may lead to reduced labor costs and increased patient compliance, thereby improving effectiveness and economic efficiency.

Quinolones have enjoyed a renaissance from the mid-1980s to today thanks to the discovery of potent, broad-spectrum fluorinated derivatives that are significant advances over older agents such as nalidixic and oxolinic acids and cinoxacin.[1] Although older fluoroquinolones such as ciprofloxacin are highly successful in the treatment of infections, new agents with improved features are needed to cover other problematic pathogens. Agents that are administered most widely are ciprofloxacin, levofloxacin, moxifloxacin, and gatifloxacin. Targets for improving the drug class are enhanced spectrum of activity against certain problematic pathogens, reduced potential for development of resistance, improved serum-tissue pharmacokinetics, reduced dosing frequency, reduced drug interaction potential, and increased tolerability.

This drug class continues to be important with established efficacy in a wide variety of clinical infections. The worldwide availability of more than a dozen agents makes it difficult to select the most appropriate ones for a formulary. A well-controlled institutional formulary and implementation of therapeutic interchange and streamlined or switch approaches are important for reducing drug expenditures.[2,3]


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