The role of fluoroquinolones in the management of skin, soft tissue, and bone infections.

The fluoroquinolones are a group of potent antimicrobials with marked in vitro activity against gram negative bacteria and, to a lesser extent, staphylococci. Their major advantages include the availability of oral preparations, relative safety, and excellent tissue penetration. Controlled clinical studies have shown that the oral quinolones are as effective as cephalexin in mild skin and soft tissue infections, and that ciprofloxacin is as effective as cefotaxime in more severe infections. Uncontrolled studies chiefly with ciprofloxacin in patients with acute and chronic osteomyelitis with staphylococci and gram negative bacteria have resulted in cure rates of 60-85%. The quinolones offer definite advances in the management of gram negative osteomyelitis and could be substituted for the aminoglycosides or third generation cephalosporins in nosocomial soft tissue infections. However, the quinolones offer no advantage over standard therapy for mild skin and soft tissue infections, particularly those caused by streptococci or methicillin-sensitive staphylococci. Development of resistant mutants may become a problem with indiscriminate use of these agents.