Synthetic antibiotics first generation quinolones were used for treatment of urinary tract infections because of their rapid excretion by kidney.
New quinolones are used in various systemic infections.
First generation: Nalidixic acid, Oxolinic acid, Pipemidic acid, Flumequin
Second generation: Pefloxacin, Norfloxacin, Ofloxacin, Ciprofloxacin, Enoxacin, Lomefloxacin
Third generation: Sparfloxacin.
18 to 23/10 million days of treatment.
In France 43 cases of anaphylaxis to quinolones were transmitted to pharmacovigilance in 1992 (first generation quinolones were almost always involved).
Sun exposure (photosensitivity).
Past exposure to quinolones or related compounds (Chloroquine, Glafenine, Tiliquinol, Nitroxolin).
General: anaphylactic shock, fever, arthralgias.
Cutaneous: maculopapular or bullous exanthema, pruritus, angioedema, fixed drug eruption and rarely Stevens-Johnson or Lyell’s disease (enoxacin, sparfoxacin and lomefloxacin are well-known to cause photosensitivity).
Differentiate from other side effects: gastrointestinal disturbance, neuropsychiatric manifestations.
Skin- prick tests and intradermal tests give false positive results.
Photo-patch tests with lomefloxacin are usually negative and cross-sensitivity with other quinolones is rarely reported.
Specific IgE: none.
Challenge test: 11 cases published.
Cross-reactivity between first and second generation quinolones +++.
Eviction (all quinolones).
If absolutely necessary: desensitization.
Ciprofloxacin 0,05 mg to 150 mg (3H).