Talk:Quinolone

message: I put a cleanup tag on this because it seems a bit all over the place. Compare with other antibiotic class articles. The adverse effects section could be a little more succinct, and a picture of the quinolone core ring system would be good. ben 14:04, 23 June 2006 (UTC)
thread_title: cleanup

message: I pulled the following text from the article:
Because of this serious problem the quinolones are generally not considered a first line agent but rather a drug of resort when therapy with other classes of antibiotics has failed or is inappropriate. It is hoped that judicious use of quinolone drugs may prolong the useful life of this group.
Jim Hoover, regional manager for state government affairs for the Bayer Corporation for the five northwest States, discussed the second and third generation quinolones. He states that "...Normally the quinolone class of drugs is used in patients who have failed at least one prior therapy. The patients tend to be fairly ill and require relatively acute care that often may be the last step before they are admitted into the hospital. …By the time the physicians get to this classification, they tend to have a good idea of what bacteria is involved, what antibiotic is the most potent for the bacteria and which penetrates that particular body side the best. …These drugs are often the last step before admission into the hospital..."Jim Hoover, Alaska Pharmacy and Therapeutics Committee March 19, 2004
Perhaps this is true in some parts of the world but FQs are very much the first-line agent in the United States, particularly in the emergency rooms (broad coverage and good bioavailability make it a "no thinking required" antibiotic). IDSA recommends it as a first-line agent for UTIs when TMP/SMX resistance is over 20% and treatment failure due to use of second-line agents cannot be tolerated, and levofloxacin has been approved for CAP. And let's not quote drug company spokespeople -- very little truth comes out of their mouths. - Emt147 Burninate! 05:36, 11 October 2006 (UTC)
thread_title:  Resistance 

message: A few notes: 
1) Bacillus anthracis is not intracellular.  If it were, it would not be susceptible to beta-lactam antibiotics (e.g., penicillin).  A fluoroquinolone (ciprofloxacin) is an effective treatment for anthrax, however.  It is the preferred means of treating inhalational anthrax.
Please note that this is no longer the case.  The CDC has withdrawn it's endorsement of Ciprofloxacin to treat Anthrax due to it's horrendous safety profile.  Doxycycline remains the first line agent for this disease state.Davidtfull (talk) 09:40, 24 January 2009 (UTC)
thread_title:  Fact adjustments 

message: According to the AAFP, gatifloxacin is 4th generation, not 3rd as suggested. Also the trade name Zymar refers to the ophthalmic solution and not to the po or iv. —The preceding unsigned comment was added by Sedmic (talk • contribs) 06:42, 15 January 2007 (UTC)
thread_title:  Generations of fluoroquinolones 

message: topo 2 is what humans have.  topo 4 is what bacteria have.  fluoroquinolones can affect both, but mainly topo 4- the target of interest.  if these drugs greatly affected topo 2 we would be in trouble (there are drugs, like anthracyclines, targeting topo 2 and they are antineoplastic).  
for some reason i have noticed people editing the article to make topo 2 a target along with dna gyrase.  this is incorrect.  quinolones work by affecting mainly topo 4 (gram positive bacteria target) and dna gyrase (gram neg target).  Brendan19 08:43, 14 May 2007 (UTC)
thread_title:  topoisomerase 4 and 2 

message: External links on Wikipedia are supposed to be "encyclopedic in nature" and useful to a worldwide audience.  Please read the external links policy (and perhaps the specific rules for medicine-related articles) before adding more external links.  
The following kinds of links are inappropriate:
*  Online discussion groups or chat forums
*  Personal webpages and blogs
*  Multiple links to the same website
*  Fundraising events or groups
*  Websites that are recruiting for clinical trials
*  Websites that are selling things (e.g., books or memberships)
I realize that some links are helpful to certain users, but they still do not comply with Wikipedia policy, and therefore must not be included in the article.  WhatamIdoing (talk) 07:11, 17 January 2008 (UTC)
thread_title: External links

message: The table at the bottom implies all but the first generation of quinolones are fluoroquinolones. The side effects and concern about fluroquinolones is so great that it would be useful to say something about the non fluorinated quinolnes. Sadly fluoroquinolone just redirects to this article. Rod57 (talk) 13:01, 9 September 2008 (UTC)
thread_title:  which are fluoroquinolones ? 

message: I see that there is some adding and reverting of external links. Would it be better if we linked to Dmoz for neutrality? Or just add it to the fluroquinolone toxicity article? I am not totally familar with external links policies.
*
or another one (scroll down)
*
--Literaturegeek | T@1k? 19:01, 16 February 2009 (UTC)
replies: text: DMOZ is always an option. WP:ELNO is quite strict, especially the first criterion. See also Talk:Quinolone#External links above for some sites which aren't eligible for inclusion. --Steven Fruitsmaak (Reply) 19:18, 16 February 2009 (UTC)
thread_title: External links (2)

message: link [20] tagged as invalid.  Perhaps the author was referring to this statement, found within the article: "Rare adverse effects attributed to some members of the quinolone family (e.g., Torsades de Pointes, hepatotoxicity, and dysglycemias) are more likely to occur in  select "susceptible" populations. "  And attributed "susceptible" to mean the elderly.  As ref [12] makes reference to the elderly too.  I believe the error here is not the two citations used.  But rather thier placement.  However this is not clear as the context is referring to overdose.  Overdose is more than likely to take place in children and the elderly I would think.  So it may not be the references but the way the sentence is structured when using them.  Either way it needs fixing.Davidtfull (talk) 18:47, 21 February 2009 (UTC)
thread_title: invalid link

message: There has been a recent edit of the opening paragraph that had been  changed as the reference used did not support the statment made, and then later removed as the statement was shown to be false, this statement was then reverted by the contributing editor back to its original form. The statement in question involves the assertion that: 
"Since bacteria and humans unwind DNA with different enzymes, human enzymes are not affected."
The first change involved the removal of the words "human enzymes" as the reference did not support their use.  The second change involved the removal of the statement as the liteature does not support it.  Additionally it is contradicted within the article (with supporting citations).  Having reverted this back to its original form the contributor has now asked that it be discussed here before being removed yet again. 
I have recently made an edit that I believe resolves these issues and allows the statement, which has been modified as follows, to remain as it is now factual in nature, where as before it was not.  That being:
"Since it is thought that bacteria and humans unwind DNA with different enzymes, most topoisomerases in eukaryotes are believed not to be affected."
If the editor is not willing to accept this compromise then I would ask that they provide documentation that clearly refutes the statements found elsewhere within the article (that proved the statement to be false to begin with) as well as citations that would support the inclusion of the term "human enzymes" in this context, as this was a replacement of the original text found within the citation that they had used, that being "topoisomerases in eukaryotes". 
Additionally, considering the subject matter addressed by this contribution I think it would be best that it be moved from the introduction and placed within the mechanism section.Davidtfull (talk) 02:59, 24 July 2009 (UTC)
thread_title: Opening paragraph

message: The last edit, there were no changes, just my error on saving. 
This edit began with disambiguation of organic quinolones from the antibacterial class.  It extends to revisions that request a bias review. Until that could be done, all safety/SAE text was gathered under preexisting headings.  Otherwise:
(1) The article needs to be retitiled, and/or split into two articles, where the organic structural class of quinolones is disambiguated from the antibacterial class which has taken its name (and which was earlier the sole emphasis of this article).
(2) It appears that at least one major contributing author/editor simply doesn't much like the overarching quinolone class of antibacterials:  count the number of positive lines and compare that to the number of negative lines. And where is it pointed out in relation to safety testing, that relative to chronic drugs such as the statins, an antibacterial of any given class/type is rarely given in any regimen approaching chronic?
Problems acknowledged, quinolones still save lives, and are not themselves (as inanimate, bioactive agents) responsible for their misuse by physicians.  If one wants the drug to be reliably used, you must simply tell the truth about it, not try to counterbalance misuses and shortcomings through imbalanced treatment.  
Until a careful and balanced consolidating edit can be done, I gathered all safety study and serious adverse event (SAE) information from its various distributed earlier locations, putting it together under headings already created by other authors. Only most offendingly inaccurate statements were actually removed or strongly edited. 
(3) Note, Trova and other NAPHTHYRIDINES need to be called out as structurally distinct antibacterial class, that is NOT, formally indicated as quinolones. Encyclopedias should not be intellectually sloppier than the (often admittedly weak) primary literature, but more careful, because its audiences are less informed.
Bottom line, much more work is needed to make this a balanced, first-class article.  Prof D  — Preceding unsigned comment added by Meduban (talk • contribs) 01:43, 14 April 2011 (UTC)
thread_title:  Serious reworking of this article needed. 

message: This article was the end result of YEARS worth of factual research and intense (and at times brutal) negotiations with the various pharmacology editors on wikipedia, and patient advocates, who ALL had worked together to present a well researched, documented and balanced article.  
The revisions made by Prof D (Meduban) have been removed and the article reverted to the original state prior to these extensive edits, as the edits are contrary to the scope and purpose of this article as well as negated the various compromises reached after years of fruitfull debate concerning the content of this article.  
As per Prof D's suggestion within this talk page, a new article was created entitled "2- and 4-quinolones", (http://en.wikipedia.org/wiki/2-_and_4-Quinolones) where the edits made by Prof D were moved and the verbage relating to the original quinolone article (that he objected to) were deleted from that article.
If Prof D wishes to discuss his own bias opinions and apparent diagreements with the compromises already reached in the pasts regarding the current quinolone article, (where the identical concerns he/she raises that had already been raised and addressed), he/she is welcome to do so on this talk page, rather than haphazardly editing the article as extensively as he had done.  
Ignoring all of the previous settled debates, thereby negating the years of hard work by the various pharmacological editors, and raising them yet again (after they had already been settled) does nothing to improve this article.  Nor does tagging every heading inappropriatedly simply because a person may disagree with the content.  Such disagreements are to be addressed on the talk page rather than by issuing mutiple and frivolous tags within an article.Davidtfull (talk) 00:17, 6 May 2011 (UTC)
thread_title:  Serious reworking of this article unneccasary and inappropriate. 

message: I removed the sentence at the beginning of the artice about "general avoidance" of fluroquinolones.  Whatever the good intentions of the person entering this sentence into the article, the requirement for a neutral point of view does not allow only one side of an issue to be presented in this way.  Specific fluoroquinolones are a first tier recommendation of The British Society for Antimicrobial Therapy for CAP: of the European Respiratory Society, the European Society of Clinical Microbiology, and the the European Society of Intensive Care Medicine for certain subsets of HAP; of the Infectious Disease Society of America for mild to moderate community acquired intra-abdominal infections, and of the IDSA for cather-associated urinary tract infections.  — Preceding unsigned comment added by Alfred Bertheim (talk • contribs) 22:00, 14 March 2012 (UTC)
thread_title:  "General Avoidance" 

message: This article is one of many in Wikipedia describing drugs classes or chemicals with demonstrated or putative toxicity.  In the vast majority of these articles, discussion of the various industrial uses, history, and technical aspects of the substance(s) in question is broken into various subheadings, including one focused on the toxicity issue.  In a few cases, such as the current one, a separate Wikipedia article focuses exclusively on the drug or chemical class's safety profile.
The present article also has a section on adverse effects, but lengthy digressions (sometimes taking up most of the section) on toxicity occur in each of the sections below.   
Introduction
Medical Uses
Contraindications
Pharmacology
Mechanism of Action
Interactions
Social and Economic Impact (which mentions ONLY toxicity, and not the uses of these drugs)
Patent Extensions
Legal Status
Boxed Warnings
Generations
Furthermore, the toxicities that have been seen with these compounds are the subject of an entirely separate and lengthy "toxicity of fluoroquinolones" article, which simply could be incorporated into this article by reference.  
As an example of a clearer, more balanced article style, I would point to the Wikipedia articles on other controversial drug classes such as antidepressants and atypical antipsychotics.  In each case the safety issues are described within the broader context of the history of the compounds, how they are used, and the science behind them.  Discussion of side effects is limited primarily to a section entitled "Adverse Events", just as discussion of patent issues is restricted to the patent issues section.  Accordingly, these articles are characterized by high readability and broad information content, and could serve as a template for a major rewrite of the present article.  — Preceding unsigned comment added by Alfred Bertheim (talk • contribs) 08:46, 10 September 2012 (UTC)
thread_title: Excessive Digressions Compromise Readability and Overall Quality

message: I think it was find the way I left it . It is a rare side effect, but a serious one.  Having both the relative risk and the absolute risk there is more informative than having only one, and neither is misleading in the presence of the other. After all ,these drugs do have a boxed warning. Formerly 98 (talk) 20:27, 22 August 2014 (UTC)
replies: text: OK, not worth fighting about. self reverted. Jytdog (talk) 22:48, 22 August 2014 (UTC)
replies: text: thanks.  Not to get into [[WP:OWN}} but I spent a lot of time thinking about the realistic assessment of the risks of these compounds while rewriting these aricles post-Davidtfull.  The risks were horrifically overstated, but I'd probably think twice about taking these drugs for a trivial infection if over age 65 or so, especially if athletically active or recently on corticosteroids. Formerly 98 (talk) 23:14, 22 August 2014 (UTC)
thread_title:  3x increase in Achille's Tendon ruptures 

message: The first reference cited in support of this claim (Unseld et al) describes EEG measurements but contains no examples of withdrawal symptoms. Furthermore it is a primary research citation and does not meet the requirements for sourcing of health-related content outlined in WP:MEDRS.
The second reference is a case report.  Case reports are explicitly called out as "a form of anecdote falling below minimal levels of medical evidence" in WP:MEDRS.
The third reference is a primary research report.  It does not meet the standards for sourcing of health-related content outlined in WP:MEDRS.
The fourth citation does not describe any examples of "sedative hypnotic withdrawal" induced by FQs.
2601:643:8100:8AF4:C4A2:D991:C7E0:9B17 (talk) 03:54, 18 October 2015 (UTC)
replies: text: OK, fair enough, that if its not in the Cipro package insert it ain't so. I'll look into finding some better references. Not the Ashton Manual, we've seen that one rejected already, although I don't know any Brit who didn't use it or a variation of it when they were in school. This is a bit frustrating since from the addictionologist's or geriatrician's viewpoint my statement is common knowledge, on the level of "cats have been domesticated for many years".Trilobitealive (talk) 04:34, 18 October 2015 (UTC)
thread_title:  Sedative hypnotic withdrawal 

message: Reasons to merge, aside from the general goal of helping readers:
*A lot of content duplication.  
*I recently cleaned up 4-Quinolones, and prefer not to duplicate that work. 
*It is the 4-Quinolones where most of the drug action is at, apparently.
Reasons maybe not to: I am not a super-expert on this area, so possibly missed something major.  --Smokefoot (talk) 17:19, 23 July 2017 (UTC)
replies: text: Question: do you think there is enough content to keep a separate article focusing on the chemistry alone? If so, I'd keep that at 4-Quinolones, merge the relevant (med/pharm) content into Quinolone, and rename Quinolone to Quinolone antibiotics—by analogy with β-lactam antibiotics, for instance. (Great work, by the way.) Fvasconcellos (t·c) 18:26, 23 July 2017 (UTC)
replies: text: Thanks for the suggestions.  Here is a possible plan.  
**Step 1: separate 2- and 4-quinolones (done this AM), creating 2-Quinolone (not plural, a narrow org. chem. topic) and 4-Quinolones (plural, grab-bag of org chem but mostly med chem)
**Step 2: merge Quinolone into 4-Quinolones (what we are talking about now).
**Step 3A: (your implied idea) shift of med chem content of 4-quinolones into quinolone antibiotics.
**step 3B: create 4-Quinolone (singular, narrow organic chem topic, analogous to 2-Quinolone). 4-Quinolone is a fundamental organic compound, it doesnt need to be long.
**Step 4: make Quinolone/Quinolones into a disambiguation site, pointing to three places  2-Quinolone, 4-Quinolone, and Quinolone antibiotics.
--Smokefoot (talk) 20:44, 23 July 2017 (UTC)
replies: text: that sounds great. Unfortunately, you've created a cut-and-paste move while implementing it. Please hold off on further edits to this page and 4-Quinolones for a second while I merge their histories. Ah, actually, you know what? Never mind. There's too much parallel history between the articles, I think a regular merge works just fine here. I don't think "step 3A" is even necessary here; I'd just delete the redirect that currently sits at Quinolone antibiotic and move 4-Quinolones over there. Fvasconcellos (t·c) 00:39, 25 July 2017 (UTC)

text: Yes, the two articles were parallel universes.  Please keep an eye on this process because these are important drugs and probably get a lot of hits.  I am worried abouta lot of double redirects and much duplication in the merged article.  It appears that the med chemists use 4-quinolone loosely to include other heterocyclic cores.  I want to eventually create 4-Quinolone as a stand-alone reference point so that the drug article does not need to cover such.  You are always welcome to intervene, warn, advise especially since I am so focused on content and can mess up on Wiki-tech.  --Smokefoot (talk) 02:09, 25 July 2017 (UTC)
thread_title: Merge into [[4-Quinolones]]?