medicina58巻5号

2021年04月発行

特集 その考えはもう古い！—最新・感染症診療 診断・治療の最新の考え方 〈治療薬・治療法再考〉

抗菌薬適正使用時代のフルオロキノロンはどう使う？

著者： 十菱大介¹

所属機関： ¹東京大学医学部付属病院感染症内科

ページ範囲：P.648 - P.653

Point
◎多数あるフルオロキノロンのうち，レボフロキサシン（LVFX），シプロフロキサシン（CPFX），モキシフロキサシン（MFLX）の3剤をおさえておくとよい．
◎フルオロキノロンは決して副作用のない薬ではないため，漫然とした使用は避ける．
◎結核の合併が否定できない市中肺炎に対しては可能な限りフルオロキノロン以外の抗菌薬を用いることが勧められる．
◎尿路感染症などに対して，経験的治療を行う前には必ず培養検体を採取する．

参考文献

1）Ball P：Quinolone generations；Natural history or natural selection? J Antimicrob Chemother 46 Suppl T1：17-24, 2000

2）Ruiz J：Transferable mechanisms of quinolone resistance from 1998 onward. Clin Microbiol Rev 32：e00007-19, 2019

activities of sitafloxacin（DU-6859a）and six other fluoroquinolones against 8,796 clinical bacterial isolates. Antimicrob Agents Chemother 44：1102-1107, 2000

4）Ryou M, Coen DM：Pharmacology of Bacterial Infections：DNA Replication, Transcription, and Translation. In Golan DE, Tashjian AH（ed）：Principles of Pharmacology；The Pathophysiologic Basis of Drug Therapy. third ed. Lippincott Williams ＆ Wilkins,Baltimore, 2012

to fluoroquinolones. Antimicrob Agents Chemother 55：3051-3053, 2011

isolates in Hong Kong, 2000 to 2005. Antimicrob Agents Chemother 51：2192-2194, 2007

7）Wang, H, et al：Antimicrobial susceptibility of bacterial pathogens associated with community-acquired respiratory tract infections in Asia；Report from the Community-Acquired Respiratory Tract Infection Pathogen Surveillance（CARTIPS）study, 2009-2010. Int J Antimicrob Agents 38：376-383, 2011

8）齋藤武文，他：「結核医療の基準」の改訂2018年．結核93：61-68, 2018

9）Nahid P, et al：Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines：Treatment of drug-ausceptible tuberculosis. Clin Infect Dis 63：e147-e195, 2016

10）Chien SC, et al：Pharmacokinetic profile of levofloxacin following once-daily 500-milligram oral or intravenous doses. Antimicrob Agents Chemother 41：2256-2260, 1997

11）Belforti RK, et al：Association between initial route of fluoroquinolone administration and outcomes in patients hospitalized for community-acquired pneumonia. Clin Infect Dis 63：1-9, 2016

12）Tunkel AR, et al：Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 39：1267-1284, 2004

13）Khaliq Y, Zhanel GG：Fluoroquinolone-associated tendinopathy；A critical review of the literature. Clin Infect Dis 36：1404-1410, 2003

14）Le Huec JC, et al：Epicondylitis after treatment with fluoroquinolone antibiotics. J Bone Joint Surg Br 77：293-295, 1995

15）Alves C,et al：Fluoroquinolones and the risk of tendon injury；A systematic review and meta-analysis. Eur J Clin Pharmacol 75：1431-1443, 2019

16）Singh S, Nautiyal A：Aortic dissection and aortic aneurysms associated with fluoroquinolones；A systematic review and meta-analysis. Am J Med 130：1449-1457, 2017

17）Rawla P,et al：Fluoroquinolones and the risk of aortic aneurysm or aortic dissection；A systematic review and meta-analysis. Cardiovasc Hematol Agents Med Chem 17：3-10, 2019

18）Kuo SC, et al：Association between recent use of fluoroquinolones and rhegmatogenous retinal detachment；A population-based cohort study. Clin Infect Dis 58：197-203, 2014

19）Metlay JP, et al：Diagnosis and treatment of adults with community-acquired pneumonia；An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 200：e45-e67, 2019

resistance in Japan；An ecological study. BMC Public Health 19：426, 2019

in a university hospital. J Antimicrob Chemother 65：2650-2657, 2010

with increased community use of moxifloxacin, levofloxacin and amoxicillin/clavulanic acid. J Antimicrob Chemother 66：664-669, 2010

isolated from urine by culture in a community setting. Clin Infect Dis 49：869-875, 2009

24）Cai T, et al：Adherence to European Association of urology guidelines on prophylactic antibiotics；An important step in antimicrobial stewardship. Eur Urol 69：276-283, 2016