Perbandingan Klinis Fluoroquinolone Generasi Baru dan Lama Pada Infeksi Saluran Kemih: dari Efikasi Hingga Keamanan
Keywords:
Fluoroquinolone, Infeksi Saluran Kemih, Efikasi, KeamananAbstract
Infeksi saluran kemih (ISK) adalah salah satu infeksi bakteri yang sering terjadi di praktik klinik. Fluoroquinolone telah lama digunakan sebagai pilihan terapi, namun kemunculan generasi baru (seperti Levofloxacin, Moxifloxacin) menimbulkan pertanyaan mengenai apakah generasi baru ini membawa keuntungan klinis dibanding generasi lama (misalnya Ciprofloxacin). Artikel review ini membandingkan bukti klinis antara Fluoroquinolone generasi lama dan baru dalam hal efikasi dan keamanan. Metode pencarian literatur mencakup basis data PubMed, Scopus, dan ScienceDirect dengan kata kunci “fluoroquinolone”, “urinary tract infection”, “efficacy”, “safety”. Hasil menunjukkan bahwa efikasi antara generasi baru dan lama tidak signifikan, tetapi kelebihan generasi baru lebih terlihat dalam aspek spektrum aktivitas dan penetrasi jaringan, tetapi kelemahan utamanya adalah ekskresi urin yang lebih rendah (terutama pada Moxifloxacin). Risiko efek samping serius (tendinopati/ruptur tendon, neuropati perifer, serta efek neurologis dan kardiovaskular) tetap menjadi perhatian penting di kedua generasi. Kesimpulannya yaitu pemilihan Fluoroquinolone generasi baru atau lama dalam ISK harus mempertimbangkan karakteristik pasien, profil resistensi lokal, dan risiko keamanan, bukan hanya efikasi semata.
References
Ackerson, B. K., Tartof, S. Y., Chen, L. H., Contreras, R., Reyes, I. A. C., Ku, J. H., Pellegrini, M., Schmidt, J. E., & Bruxvoort, K. J. (2024). Risk Factors for Recurrent Urinary Tract Infections Among Women in a Large Integrated Health Care Organization in the United States. Journal of Infectious Diseases, 230(5), e1101–e1111. https://doi.org/10.1093/infdis/jiae331
Anwar, A. I., Lu, L., Plaisance, C. J., Daniel, C. P., Flanagan, C. J., Wenger, D. M., McGregor, D., Varrassi, G., Kaye, A. M., Ahmadzadeh, S., Cornett, E. M., Shekoohi, S., & Kaye, A. D. (2024). Fluoroquinolones: Neurological Complications and Side Effects in Clinical Practice. Cureus. https://doi.org/10.7759/cureus.54565
Artero, A., López-Cruz, I., Piles, L., Alberola, J., Eiros, J. M., Salavert, S., & Madrazo, M. (2023). Fluoroquinolones Are Useful as Directed Treatment for Complicated UTI in a Setting with a High Prevalence of Quinolone-Resistant Microorganisms. Antibiotics, 12(1). https://doi.org/10.3390/antibiotics12010183
Barberán, J., De La Cuerda, A., González, M. I. T., Aparicio, A. L., Vinuesa, C. M., Sánchez, A. R., & Barberán, L. C. (2024). Safety of fluoroquinolones. In Revista Espanola de Quimioterapia (Vol. 37, Issue 2, pp. 127–133). Sociedad Espanola de Quiminoterapia. https://doi.org/10.37201/req/143.2023
Berti, F., Attardo, T. M., Piras, S., Tesei, L., Tirotta, D., Tonani, M., Castellini, G., Gianola, S., & Minozzi, S. (2018). Short versus long course antibiotic therapy for acute pyelonephritis in adults: A systematic review and meta-analysis. In Italian Journal of Medicine (Vol. 12, Issue 1, pp. 39–50). Page Press Publications. https://doi.org/10.4081/itjm.2018.840
Cao, D., Shen, Y., Huang, Y., Chen, B., Chen, Z., Ai, J., Liu, L., Yang, L., & Wei, Q. (2021). Levofloxacin Versus Ciprofloxacin in the Treatment of Urinary Tract Infections: Evidence-Based Analysis. In Frontiers in Pharmacology (Vol. 12). Frontiers Media S.A. https://doi.org/10.3389/fphar.2021.658095
Chao, Y.S., & Farrah, K. (2019). Fluoroquinolones for the Treatment of Urinary Tract Infection. CADTH.
Charoo, N. A., Abdallah, D. B., Parveen, T., Abrahamsson, B., Cristofoletti, R., Groot, D. W., Langguth, P., Parr, A., Polli, J. E., Mehta, M., Shah, V. P., Tajiri, T., & Dressman, J. (2020). Biowaiver Monograph for Immediate-Release Solid Oral Dosage Forms: Moxifloxacin Hydrochloride. In Journal of Pharmaceutical Sciences (Vol. 109, Issue 9, pp. 2654–2675). Elsevier B.V. https://doi.org/10.1016/j.xphs.2020.06.007
Daneman, N., Chateau, D., Dahl, M., Zhang, J., Fisher, A., Sketris, I. S., Quail, J., Marra, F., Ernst, P., & Bugden, S. (2020). Fluoroquinolone use for uncomplicated urinary tract infections in women: a retrospective cohort study. Clinical Microbiology and Infection, 26(5), 613–618. https://doi.org/10.1016/j.cmi.2019.10.016
Flores-Mireles, A. L., Walker, J. N., Caparon, M., & Hultgren, S. J. (2015). Urinary tract infections: Epidemiology, mechanisms of infection and treatment options. In Nature Reviews Microbiology (Vol. 13, Issue 5, pp. 269–284). Nature Publishing Group. https://doi.org/10.1038/nrmicro3432
García-Meniño, I., García, V., Lumbreras-Iglesias, P., Fernández, J., & Mora, A. (2024). Fluoroquinolone resistance in complicated urinary tract infections: association with the increased occurrence and diversity of Escherichia coli of clonal complex 131, together with ST1193. Frontiers in Cellular and Infection Microbiology, 14. https://doi.org/10.3389/fcimb.2024.1351618
Geremia, N., Giovagnorio, F., Colpani, A., De Vito, A., Botan, A., Stroffolini, G., Toc, D. A., Zerbato, V., Principe, L., Madeddu, G., Luzzati, R., Parisi, S. G., & Di Bella, S. (2024). Fluoroquinolones and Biofilm: A Narrative Review. In Pharmaceuticals (Vol. 17, Issue 12). Multidisciplinary Digital Publishing Institute (MDPI). https://doi.org/10.3390/ph17121673
Kon, S., Meslovich, D., Valdez, C., Jenkins, T. C., Shihadeh, K., Franco-Paredes, C., & Price, C. S. (2022). Long-term impact of fluoroquinolone-sparing strategies for empirical treatment of acute uncomplicated cystitis among ambulatory patients. Therapeutic Advances in Infectious Disease, 9. https://doi.org/10.1177/20499361221129415
Lee, S. H., & Le, J. (2018). Urinary Tract Infection. In J. E. Murphy & M. W. Lee (Eds.), Pharmacotherapy Self-Assessment Program (PSAP) (pp. 7–26). American College of Clinical Pharmacy.
Mitrani-Gold, F. S., Ju, S., Drysdale, M., Schultze, A., Mu, G., & Logie, J. (2024). Risk of collagen-related disorders and neurological events among patients with uncomplicated urinary tract infection following short treatment with fluoroquinolones: a cohort study. Antimicrobial Agents and Chemotherapy, 68(12). https://doi.org/10.1128/aac.00690-24
Mospan, G. A., & Wargo, K. A. (2016). 5-Day versus 10-day course of fluoroquinolones in outpatient males with a urinary tract infection (UTI). Journal of the American Board of Family Medicine, 29(6), 654–662. https://doi.org/10.3122/jabfm.2016.06.160065
Pham, T. D. M., Ziora, Z. M., & Blaskovich, M. A. T. (2019). Quinolone antibiotics. In MedChemComm (Vol. 10, Issue 10, pp. 1719–1739). Royal Society of Chemistry. https://doi.org/10.1039/c9md00120d
Ruiz-Lievano, A. P., Cervantes-Flores, F., Nava-Torres, A., Carbajal-Morales, P. J., Villaseñor-Garcia, L. F., & Zavala-Cerna, M. G. (2024). Fluoroquinolone Resistance in Escherichia coli Causing Community-Acquired Urinary Tract Infections: A Systematic Review. In Microorganisms (Vol. 12, Issue 11). Multidisciplinary Digital Publishing Institute (MDPI). https://doi.org/10.3390/microorganisms12112320
Sangiorgio, A., Sirone, M., Adravanti, F. M., Testa, E. A., Riegger, M., & Filardo, G. (2024). Achilles tendon complications of fluoroquinolone treatment: a molecule-stratified systematic review and meta-analysis. EFORT Open Reviews, 9(7), 581–588. https://doi.org/10.1530/EOR-23-0181
Schneider-Smith, E., Bacher, B., Morgan-Gillard, X., Yaeger, L., Durkin, M. J., & Marschall, J. (2023). Short versus long antibiotic treatment duration for febrile urinary tract infection and acute pyelonephritis: A systematic review and meta-analysis.
Sharapova, A., Ol’khovich, M., Blokhina, S., Zhirova, E., & Perlovich, G. (2021). Solubility and partition behavior of moxifloxacin: Experimental results and thermodynamics properties. Journal of Molecular Liquids, 339. https://doi.org/10.1016/j.molliq.2021.116814
Swingler, E. A., Song, M., Moore, S. E., Bohn, B. C., Schulz, P. S., Junkins, A. D., & Wilde, A. M. (2022). Fluoroquinolone stewardship at a community health system: A decade in review. Antimicrobial Stewardship and Healthcare Epidemiology, 2(1). https://doi.org/10.1017/ash.2022.326
Tamma, P. D., Heil, E. L., Ann Justo, J., Mathers, A. J., Satlin, M. J., Bonomo, R. A., & Author, C. (2024). Infectious Diseases Society of America 2024 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections. www.idsociety.org/practice-guideline/amr-guidance/.
Trautner, B. W., Cortés-Penfield, N. W., Gupta, K., Hirsch, E. B., Horstman, M., Moran, G. J., Colgan, R., O’horo, J. C., Ashraf, M. S., Connolly, S., Drekonja, D., Grigoryan, L., Huttner, A., Lazenby, G. B., Nicolle, L., Schaeffer, A., Yawetz, S., & Lavergne, V. (2025). Clinical Practice Guideline by Infectious Diseases Society of America (IDSA): 2025 Guideline on Management and Treatment of Complicated Urinary Tract Infections: Executive Summary.
U.S. Food and Drug Administration. (2018). FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients.
Varma, M. V., Steyn, S. J., Allerton, C., & El-Kattan, A. F. (2015). Predicting Clearance Mechanism in Drug Discovery: Extended Clearance Classification System (ECCS). In Pharmaceutical Research (Vol. 32, Issue 12, pp. 3785–3802). Springer New York LLC. https://doi.org/10.1007/s11095-015-1749-4
Xue, Z., Xiang, Y., Li, Y., & Yang, Q. (2021). A systematic review and meta-analysis of levofloxacin and ciprofloxacin in the treatment of urinary tract infection. Annals of Palliative Medicine, 10(9), 9765–9771. https://doi.org/10.21037/apm-21-2042
