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A review on the impact of 4-quinolones on the normal oropharyngeal and intestinal human microflora

Einfluß der 4-Chinolone auf die normale oropharyngeale und intestinale Flora des Menschen. Übersicht

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Summary

During the last few years the impact of the newer 4-quinolones, ciprofloxacin, enoxacin, norfloxacin, ofloxacin and pefloxacin, on the human microflora has been studied by several investigators. This review article summarizes the published data concerning these studies. The results show that the oropharyngeal flora is affected only slightly or not at all by the 4-quinolones. All the newer 4-quinolones have a similar effect on the normal intestinal flora. The gram-negative aerobic flora is strongly suppressed during administration of 4-quinolones, while the gram-positive flora is only slightly affected. The anaerobic microflora is hardly affected at all. The emergence of resistant bacterial strains is uncommon, although one study shows increased MIC-values for anaerobes during ciprofloxacin administration. Replacement by yeasts or other inherently resistant microorganisms does not often seem to be a problem. High concentrations of the 4-quinolones are reached in faeces, values between 100–2,200 mg/kg being reported. Since the 4-quinolones do not cause marked ecological disturbances in the intestinal microflora, they may be suitable for selective decontamination in immunocompromised patients, for prophylaxis of urinary tract infections and for treatment of bacterial intestinal infections.

Zusammenfassung

In den vergangenen Jahren wurden mehrere Untersuchungen zur Beeinflussung der menschlichen Mikroflora durch die neuen 4-Chinolone Ciprofloxacin, Enoxacin, Norfloxacin, Ofloxacin und Pefloxacin durchgeführt. Die vorliegende Übersichtsarbeit faßt die aus diesen Studien publizierten Daten zusammen. Die Ergebnisse zeigen, daß 4-Chinolone die oropharyngeale Flora und auch die normale Darmflora kaum oder überhaupt nicht verändern. Unter der Therapie mit 4-Chinolonen ist die aerobe gramnegative Flora stark supprimiert, die grampositive Flora dagegen kaum beeinträchtigt. Die anaerobe Mikroflora wird kaum verändert. Nur selten treten resistente Bakterienstämme auf. In einer Studie wurden allerdings unter Behandlung mit Ciprofloxacin erhöhte MHK-Werte für Anaerobier festgestellt. Zu einer Verdrängung der normalen Flora zugunsten von Hefen oder anderen Mikroorganismen mit inhärenter Resistenz kommt es offensichtlich nur selten. 4-Chinolone werden in hoher Konzentration in den Faeces gefunden, die publizierten Konzentrationen liegen zwischen 100 und 2200 mg/kg. Da die 4-Chinolone die Ökologie der Mikroflora des Darmes nicht wesentlich beeinträchtigen, eignen sie sich möglicherweise für die selektive Dekontamination bei abwehrgeschwächten Patienten, die Prophylaxe von Harnwegsinfektionen und Behandlung intestinaler bakterieller Infektionen.

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Edlund, C., Nord, C.E. A review on the impact of 4-quinolones on the normal oropharyngeal and intestinal human microflora. Infection 16, 8–12 (1988). https://doi.org/10.1007/BF01646921

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