Pharmacokinetic/pharmacodynamic target-based dose optimization of quinolones

Quinolones are widely used for the treatment of bacterial infections because of their broad antimicrobial spectrum, favorable tissue penetration, and concentration-dependent bactericidal activity. Optimization of quinolone dosing regimens based on pharmacokinetic/pharmacodynamic (PK/PD) principles is essential for improving clinical efficacy, minimizing toxicity, and limiting the emergence of bacterial resistance. As concentration-dependent antibacterial agents, quinolones are primarily characterized by PK/PD efficacy indices such as ratio of the 24-h area under the concentration-time curve to the minimum inhibitory concentration (AUC 24 /MIC) and the ratio of peak concentration to MIC (C max /MIC), whereasmutant prevention concentration (MPC)-related indices may provide additional insight into resistance suppression. This review summarizes the pharmacokinetic, pharmacodynamic, and PK/PD characteristics of quinolones and highlights the clinical application of PK/PD-guided dose optimization for representative agents, including norfloxacin, ciprofloxacin, levofloxacin, moxifloxacin, and newer quinolones such as nemonoxacin, sitafloxacin, and delafloxacin. The aim is to provide both a theoretical basis and practical guidance for the rational clinical use and individualized dose optimization of quinolones.