The role of fluoroquinolones in skin and skin structure infections.

Skin and skin structure infections encompass a broad range of clinical presentations and disease severity. Antimicrobial therapy is clearly beneficial for both recovery from these infections as well as preventing disease progression. Fluoroquinolones are potent broad spectrum antimicrobial agents with the older agents characterized as having broad spectrum anti-Gram-negative activity, borderline activity against clinically important Gram-positive pathogens and little or no anti-anaerobic bacteria activity. In contrast, the new quinolones are characterized by having enhanced activity against Gram-positive pathogens, anti-anaerobic activity and they remain highly active against aerobic-Gram-negative bacilli. Several fluoroquinolones have been evaluated for the treatment of uncomplicated skin and soft tissue infection, difficult skin and soft tissue infection and serious skin and skin structure infections. Clinical cure rates were found to be equivalent to comparators suggesting a role for the fluoroquinolone in treating these infections. It may be necessary to use some fluoroquinolones in combination with anti-anaerobic agents for those infections with mixed aerobic and anaerobic pathogens. Some additional clinical trials are necessary to identify the full potential of newer fluoroquinolones for skin and skin structure infections. At present, quinolones are, in general, equivalent to beta-lactam agents in the treatment of skin and soft tissue infection.