Fluoroquinolones and Biofilm: A Narrative Review

<b>Background</b>: Biofilm-associated infections frequently span multiple body sites and represent a significant clinical challenge, often requiring a multidisciplinary approach involving surgery and antimicrobial therapy. These infections are commonly healthcare-associated and frequentl...

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Main Authors: Nicholas Geremia, Federico Giovagnorio, Agnese Colpani, Andrea De Vito, Alexandru Botan, Giacomo Stroffolini, Dan-Alexandru Toc, Verena Zerbato, Luigi Principe, Giordano Madeddu, Roberto Luzzati, Saverio Giuseppe Parisi, Stefano Di Bella
Format: Article
Language:English
Published: MDPI AG 2024-12-01
Series:Pharmaceuticals
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Online Access:https://www.mdpi.com/1424-8247/17/12/1673
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author Nicholas Geremia
Federico Giovagnorio
Agnese Colpani
Andrea De Vito
Alexandru Botan
Giacomo Stroffolini
Dan-Alexandru Toc
Verena Zerbato
Luigi Principe
Giordano Madeddu
Roberto Luzzati
Saverio Giuseppe Parisi
Stefano Di Bella
author_facet Nicholas Geremia
Federico Giovagnorio
Agnese Colpani
Andrea De Vito
Alexandru Botan
Giacomo Stroffolini
Dan-Alexandru Toc
Verena Zerbato
Luigi Principe
Giordano Madeddu
Roberto Luzzati
Saverio Giuseppe Parisi
Stefano Di Bella
author_sort Nicholas Geremia
collection DOAJ
description <b>Background</b>: Biofilm-associated infections frequently span multiple body sites and represent a significant clinical challenge, often requiring a multidisciplinary approach involving surgery and antimicrobial therapy. These infections are commonly healthcare-associated and frequently related to internal or external medical devices. The formation of biofilms complicates treatment, as they create environments that are difficult for most antimicrobial agents to penetrate. Fluoroquinolones play a critical role in the eradication of biofilm-related infections. Numerous studies have investigated the synergistic potential of combining fluoroquinolones with other chemical agents to augment their efficacy while minimizing potential toxicity. Comparative research suggests that the antibiofilm activity of fluoroquinolones is superior to that of beta-lactams and glycopeptides. However, their activity remains less effective than that of minocycline and fosfomycin. Noteworthy combinations include fluoroquinolones with fosfomycin and aminoglycosides for enhanced activity against Gram-negative organisms and fluoroquinolones with minocycline and rifampin for more effective treatment of Gram-positive infections. Despite the limitations of fluoroquinolones due to the intrinsic characteristics of this antibiotic, they remain fundamental in this setting thanks to their bioavailability and synergisms with other drugs. <b>Methods</b>: A comprehensive literature search was conducted using online databases (PubMed/MEDLINE/Google Scholar) and books written by experts in microbiology and infectious diseases to identify relevant studies on fluoroquinolones and biofilm. <b>Results</b>: This review critically assesses the role of fluoroquinolones in managing biofilm-associated infections in various clinical settings while also exploring the potential benefits of combination therapy with these antibiotics. <b>Conclusions</b>: The literature predominantly consists of in vitro studies, with limited in vivo investigations. Although real world data are scarce, they are in accordance with fluoroquinolones’ effectiveness in managing early biofilm-associated infections. Also, future perspectives of newer treatment options to be placed alongside fluoroquinolones are discussed. This review underscores the role of fluoroquinolones in the setting of biofilm-associated infections, providing a comprehensive guide for physicians regarding the best use of this class of antibiotics while highlighting the existing critical issues.
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spelling doaj-art-2cd041ebf90b4f138f9feab178095fa52025-08-20T02:56:57ZengMDPI AGPharmaceuticals1424-82472024-12-011712167310.3390/ph17121673Fluoroquinolones and Biofilm: A Narrative ReviewNicholas Geremia0Federico Giovagnorio1Agnese Colpani2Andrea De Vito3Alexandru Botan4Giacomo Stroffolini5Dan-Alexandru Toc6Verena Zerbato7Luigi Principe8Giordano Madeddu9Roberto Luzzati10Saverio Giuseppe Parisi11Stefano Di Bella12Unit of Infectious Diseases, Department of Clinical Medicine, Ospedale “dell’Angelo”, 30174 Venice, ItalyDepartment of Molecular Medicine, University of Padua, 35121 Padua, ItalyUnit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, ItalyUnit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, ItalyFaculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, RomaniaDepartment of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, ItalyDepartment of Microbiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, RomaniaInfectious Diseases Unit, Trieste University Hospital (ASUGI), 34125 Trieste, ItalyClinical Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi-Melacrino-Morelli”, 89128 Reggio di Calabria, ItalyUnit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, ItalyClinical Department of Medical, Surgical and Health Sciences, Trieste University, 34129 Trieste, ItalyDepartment of Molecular Medicine, University of Padua, 35121 Padua, ItalyClinical Department of Medical, Surgical and Health Sciences, Trieste University, 34129 Trieste, Italy<b>Background</b>: Biofilm-associated infections frequently span multiple body sites and represent a significant clinical challenge, often requiring a multidisciplinary approach involving surgery and antimicrobial therapy. These infections are commonly healthcare-associated and frequently related to internal or external medical devices. The formation of biofilms complicates treatment, as they create environments that are difficult for most antimicrobial agents to penetrate. Fluoroquinolones play a critical role in the eradication of biofilm-related infections. Numerous studies have investigated the synergistic potential of combining fluoroquinolones with other chemical agents to augment their efficacy while minimizing potential toxicity. Comparative research suggests that the antibiofilm activity of fluoroquinolones is superior to that of beta-lactams and glycopeptides. However, their activity remains less effective than that of minocycline and fosfomycin. Noteworthy combinations include fluoroquinolones with fosfomycin and aminoglycosides for enhanced activity against Gram-negative organisms and fluoroquinolones with minocycline and rifampin for more effective treatment of Gram-positive infections. Despite the limitations of fluoroquinolones due to the intrinsic characteristics of this antibiotic, they remain fundamental in this setting thanks to their bioavailability and synergisms with other drugs. <b>Methods</b>: A comprehensive literature search was conducted using online databases (PubMed/MEDLINE/Google Scholar) and books written by experts in microbiology and infectious diseases to identify relevant studies on fluoroquinolones and biofilm. <b>Results</b>: This review critically assesses the role of fluoroquinolones in managing biofilm-associated infections in various clinical settings while also exploring the potential benefits of combination therapy with these antibiotics. <b>Conclusions</b>: The literature predominantly consists of in vitro studies, with limited in vivo investigations. Although real world data are scarce, they are in accordance with fluoroquinolones’ effectiveness in managing early biofilm-associated infections. Also, future perspectives of newer treatment options to be placed alongside fluoroquinolones are discussed. This review underscores the role of fluoroquinolones in the setting of biofilm-associated infections, providing a comprehensive guide for physicians regarding the best use of this class of antibiotics while highlighting the existing critical issues.https://www.mdpi.com/1424-8247/17/12/1673fluoroquinolonebiofilmbiofilm-forming infectionsfluoroquinolone and biofilmantibiotic therapy
spellingShingle Nicholas Geremia
Federico Giovagnorio
Agnese Colpani
Andrea De Vito
Alexandru Botan
Giacomo Stroffolini
Dan-Alexandru Toc
Verena Zerbato
Luigi Principe
Giordano Madeddu
Roberto Luzzati
Saverio Giuseppe Parisi
Stefano Di Bella
Fluoroquinolones and Biofilm: A Narrative Review
Pharmaceuticals
fluoroquinolone
biofilm
biofilm-forming infections
fluoroquinolone and biofilm
antibiotic therapy
title Fluoroquinolones and Biofilm: A Narrative Review
title_full Fluoroquinolones and Biofilm: A Narrative Review
title_fullStr Fluoroquinolones and Biofilm: A Narrative Review
title_full_unstemmed Fluoroquinolones and Biofilm: A Narrative Review
title_short Fluoroquinolones and Biofilm: A Narrative Review
title_sort fluoroquinolones and biofilm a narrative review
topic fluoroquinolone
biofilm
biofilm-forming infections
fluoroquinolone and biofilm
antibiotic therapy
url https://www.mdpi.com/1424-8247/17/12/1673
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