The quinolones (e.g., ciprofloxacin, levofloxacin, moxifloxacin, and gatifloxacin) inhibit MAC bacteria in vitro. M. fortuitum and M. kansasii also are sensitive to these quinolones but M. chelonae usually are resistant. Single-agent therapy of M. fortuitum infection with ciprofloxacin has led to resistance. Ciprofloxacin, 750 mg twice daily or 500 mg three times daily, has been used in a 4-drug regimen (with clarithromycin, rifabutin, and amikacin) as salvage therapy for MAC infections in HIV-infected patients. Multidrug-resistant tuberculosis has been treated with ofloxacin,
300 or 800 mg/day, in combination with second-line agents. Moxifloxacin and gatifloxacin are more active than the older fluoroquinolones and would be expected to be useful agents clinically. For more on the quinolones, see Chapter 43.
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