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Quinolone Antimicrobial Agents. 3rd Ed.
  1. K G Kerr

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    Edited by D C Hooper, E Rubinstein. Washington: ASM Press, 2003, $125.95, pp 485. ISBN 1-55581-231-7

    In 1984, as a wet behind the ears house officer, I remember waiting with great anticipation for the new wonder drug ciprofloxacin to arrive by motorcycle courier so that it could be used for a patient with refractory febrile neutropenia. Nowadays, quinolones such as ciprofloxacin have become so widely used that it may be difficult for younger bacteriologists to imagine BBQ (bacteriology before quinolones)! The important place that these compounds have assumed in the antimicrobial pharmacopoeia is reflected by the fact that this is the third edition of this text in 10 years.

    The book is divided into four sections, covering mechanisms and spectrum of antibacterial activity and resistance; pharmacology; clinical applications; and adverse and other effects. For a USA produced book, it is refreshing to see a truly international line up of contributors. Inevitably, for a work that is so broad in its outlook, it is unlikely that every chapter, particularly in the first two sections, will be consulted with equal frequency— for example, the chapter on structure–activity relations of the quinolones is unlikely to whip the jobbing clinical bacteriologist into an uncontrolled state of frenzied excitement. However, this is not to say that all of the non-clinical chapters will go unread by those with a more clinical orientation—the chapters on mechanisms of action and resistance make interesting reading. The clinical applications section accounts for 16 of the book’s 30 chapters and includes chapters on the use of quinolones in the management of intra-abdominal infections and infections caused by intracellular pathogens, and the use of these drugs in intensive care unit infections and, perhaps of most interest, paediatrics; none of these areas appeared in the second edition of the book. Quinolone resistance is revisited again in this section, but there is little overlap with earlier chapters. Donald Low’s excellent chapter on the clinical relevance of quinolone resistance is one of the highlights of the book, and the chapter on the impact of veterinary use of these drugs on resistance in bacterial isolates from human infection makes sobering reading, and emphasises the fact that there is still much to be done in limiting the use of these drugs in the agricultural sector.

    The infamous list of quinolones withdrawn before or after reaching the market place because of serious toxicity must be the cause of many a sleepless night for some of those employed by the pharmaceutical industry, and the final section of the book considers these toxicities in detail.

    Several chapters throughout the book stray a little from their remit—for example, the one which deals with QT prolongation by quinolones includes a rather too detailed discussion of electrophysiology, and the chapter on the treatment of intracellular infection focuses much of its attention on the use of other drugs, such as tetracyclines and macrolides, in this setting. I would also have liked to have seen more discussion concerning the accumulating evidence linking quinolones with the emergence of methicillin resistant Staphyloccus aureus. Nevertheless, these are relatively minor criticisms, and the book would make a valuable addition to the departmental library of any clinical microbiology laboratory.

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