Preface

Substantial progress has been made in the development of newer qui-nolones since the last edition of The Quinolones was published. This progress occurred because the quinolone class of antibacterial agents has captured the interest of chemists, microbiologists, pharmacologists, and clinicians. Recent progress in molecular biology has provided new information and a better understanding of structure-activity relationships of the quinolone nucleus and its radicals. This progress has resulted in the approval of a few new compounds with improved mechanism of action and the potential for delaying the development of resistance by specific bacterial pathogens. A few of the newest quinolones developed recently— moxifloxacin, gatifloxacin, and gemifloxacin—provide a more potent spectrum of activity that includes penicillin-resistant pneumococci as well as good activity against anaerobes and decreased susceptibility to the development of resistance by some bacterial species. Trovafloxacin was the first quinolone that demonstrated improved penetration into the central nervous system and cerebrospinal fluid, and early clinical studies demonstrated excellent efficacy in pediatric patients with bacterial meningitis. The newest quinolones—moxifloxacin, gatifloxacin, and gemifloxacin— broaden the clinical utility of this class of antimicrobial agents as we enter an era of increasing bacterial resistance to the previously recommended "standard therapy. " During this same period, we have learned much about quinolone toxicity as it relates to quinolone chemical structure and phar-macokinetics/pharmacodynamics in treated patients. Hopefully this knowledge will provide safer molecules for use in patients.

The excellent and very recent progress that has occurred warranted an update on the quinolones. This edition is intended to provide the newest and most cogent information on the quinolones—all of it readily available in one volume.

Once again, I am much indebted to my colleagues, each of whom contributed thorough reviews on the history, chemistry, and mechanism of action, in-vitro properties, mechanisms of bacterial resistance, pharmacokinetics, clinical overview (described in nine separate chapters, including pediatrics), toxicity, adverse effects and drug interactions, and the future prospects of the newer quinolones.

Clearly, our hope is that this work will serve as a ready resource for new and helpful information, and, in so doing, the efforts of my colleagues most certainly will have been worthwhile.

Vincent T. Andriole Yale University School of Medicine

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