Cost and dosing issues.

Twice-daily dosing is recommended for ciprofloxacin for most indications. Trovafloxacin and grepafloxacin can be administered once-daily. Levofloxacin should probably be administered twice daily in serious, life-threatening infections. The acquisition cost of ciprofloxacin is currently higher than the newer agents, but a lower acquisition cost does not necessarily mean a lower overall cost of treatment. A cheaper agent which is less effective or safe just shifts costs to other areas by creating further clinical problems with their attendant costs. The total costs associated with treatment with newer agents are as yet undefined. Restricting the prescription of a particular antibiotic may result in the increased use of an alternative regimen which may cost the same or even more than the original ('cost shifting'). This interesting observation needs to be substantiated with future research. Ciprofloxacin is available in both intravenous and oral formulations and suitable for sequential intravenous-oral therapy with its attendant benefits. It is currently the gold-standard quinolone in the hospital setting for a broad range of infections, particularly Pseudomonas aeruginosa infections. Initially, the newer quinolones are most likely to be used to treat severe, community-acquired pneumonia.