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Fluoroquinolones - MCQs (Based on Your Notes)

Section A: Classification & History

1. Nalidixic acid, the first quinolone, was discovered during an attempted synthesis of which drug? A) Quinine B) Chloroquine C) Primaquine D) Mefloquine

Answer: B - Chloroquine

2. Which generation of fluoroquinolones has the LEAST activity against gram-positive organisms but retains anti-pseudomonal coverage? A) 1st generation B) 2nd generation C) 3rd generation D) 4th generation

Answer: A - 1st generation (e.g., cinoxacin, nalidixic acid, oxolinic acid)

3. Which of the following is a 4th generation fluoroquinolone with significant anaerobic activity but limited use due to hepatotoxicity? A) Gemifloxacin B) Moxifloxacin C) Trovafloxacin D) Gatifloxacin

Answer: C - Trovafloxacin

4. A drug active in vitro against ciprofloxacin-resistant strains of S. pneumoniae belongs to which generation? A) 1st (nalidixic acid) B) 2nd (ciprofloxacin) C) 3rd (gemifloxacin) D) None of the above

Answer: C - 3rd generation (gemifloxacin)

Section B: Mechanism of Action & Resistance

5. Fluoroquinolones exert their bactericidal effect primarily by inhibiting which two bacterial enzymes? A) RNA polymerase and ribosomal subunit 50S B) DNA gyrase (topoisomerase II) and topoisomerase IV C) Dihydrofolate reductase and dihydropteroate synthase D) Peptidyl transferase and transpeptidase

Answer: B - DNA gyrase and topoisomerase IV

6. Inhibition of DNA gyrase by fluoroquinolones primarily prevents: A) Cell wall cross-linking B) Relaxation of positively supercoiled DNA needed for transcription/replication C) Protein synthesis at the 30S ribosomal subunit D) Folate synthesis

Answer: B

7. Plasmid-mediated fluoroquinolone resistance can occur through which mechanism? A) Beta-lactamase production B) Qnr proteins protecting DNA gyrase C) Methylation of 23S rRNA D) Efflux pump upregulation only

Answer: B - Qnr (pentapeptide repeat) proteins protecting DNA gyrase; a variant aminoglycoside acetyltransferase modifying ciprofloxacin is the other described mechanism

8. Resistance to one fluoroquinolone, especially high-level resistance, typically results in: A) No effect on other class members B) Cross-resistance to all other fluoroquinolones C) Increased susceptibility to beta-lactams D) Selective resistance to only 4th generation agents

Answer: B

Section C: Pharmacokinetics & Interactions

9. Oral bioavailability of fluoroquinolones is typically in which range? A) 20-40% B) 40-60% C) 80-95% D) Less than 10%

Answer: C

10. Fluoroquinolone absorption is significantly reduced when co-administered with: A) Beta-blockers B) Divalent/trivalent cations (antacids, iron) C) Proton pump inhibitors D) Statins

Answer: B - patients should separate dosing by 2 hours before or 4 hours after these products

11. A 68-year-old man with a creatinine clearance of 35 mL/min is started on levofloxacin. What is the most appropriate action? A) No change needed, fluoroquinolones are hepatically cleared B) Dosage adjustment required since most fluoroquinolones are renally eliminated C) Double the dose for adequate coverage D) Switch to nalidixic acid instead

Answer: B

12. Ciprofloxacin increases plasma concentrations of all of the following EXCEPT: A) Theophylline B) Warfarin C) Caffeine D) Amoxicillin

Answer: D - amoxicillin is not affected; theophylline, warfarin and caffeine levels rise with ciprofloxacin co-administration

Section D: Clinical Uses

13. Which fluoroquinolone is the drug of choice for anthrax prophylaxis and treatment? A) Levofloxacin B) Ciprofloxacin C) Moxifloxacin D) Gemifloxacin

Answer: B

14. "Respiratory fluoroquinolones," useful for CAP and acute bronchitis exacerbations, refer to: A) Ciprofloxacin and norfloxacin B) Nalidixic acid and cinoxacin C) Levofloxacin and moxifloxacin D) Ofloxacin and lomefloxacin

Answer: C

15. A patient with cystic fibrosis has a pseudomonal pulmonary infection. Which class of antibiotics is often used despite the theoretical risk of arthropathy, because benefit outweighs risk? A) Aminoglycosides B) Fluoroquinolones C) Macrolides D) Tetracyclines

Answer: B

16. Which fluoroquinolone is preferred for osteomyelitis due to Pseudomonas aeruginosa given its excellent bone penetration and oral bioavailability? A) Nalidixic acid B) Ciprofloxacin C) Trovafloxacin D) Gemifloxacin

Answer: B

Section E: Adverse Effects

17. A patient on gatifloxacin develops torsades de pointes. This is most likely due to: A) Hepatotoxicity B) QTc interval prolongation C) Nephrotoxicity D) Ototoxicity

Answer: B

18. Fluoroquinolones are generally avoided in children under 18 due to risk of: A) Irreversible hepatotoxicity B) Arthropathy from cartilage damage (reversible) C) Permanent hearing loss D) Aplastic anemia

Answer: B

19. Which fluoroquinolones have been specifically associated with photosensitivity reactions? A) Ciprofloxacin and levofloxacin B) Lomefloxacin and pefloxacin C) Moxifloxacin and gemifloxacin D) Nalidixic acid and cinoxacin

Answer: B

20. A 70-year-old patient on chronic corticosteroid therapy develops sudden calf pain and swelling while on levofloxacin. The most likely diagnosis is: A) Deep vein thrombosis B) Tendon rupture secondary to tendonitis C) Arthropathy D) Peripheral neuropathy

Answer: B - advanced age, renal insufficiency, and concurrent steroid use are risk factors for fluoroquinolone-induced tendonitis/rupture

21. Which CNS adverse effect mechanism is attributed to fluoroquinolones? A) Blockade of dopamine receptors B) Displacement of GABA from its receptors C) Serotonin syndrome D) NMDA receptor antagonism

Answer: B - can cause seizures, insomnia, confusion, dizziness, anxiety

Quick summary table for revision:

Generation	Drugs	Key Feature
1st	Nalidixic acid, cinoxacin	UTI only, minimal serum levels
2nd	Ciprofloxacin, norfloxacin, ofloxacin, levofloxacin	Strong Gram-negative, moderate Gram-positive
3rd	Gatifloxacin, gemifloxacin	Improved Gram-positive (S. pneumoniae)
4th	Moxifloxacin, trovafloxacin	Anaerobic coverage; trovafloxacin - hepatotoxic

Let me know if you'd like this exported as a Word document or PowerPoint quiz deck, or if you want a harder set with clinical vignettes for exam practice.

More MCQs as much as possible on every single topic

Fluoroquinolones - Comprehensive MCQ Bank (All Topics)

Organized by topic exactly as per your notes, with answers and brief rationale after each block.

Section 1: Introduction & History

1. Fluoroquinolones are synthetic derivatives of which parent compound? A) Penicillin B) Nalidixic acid C) Sulfanilamide D) Erythromycin Answer: B

2. Nalidixic acid was first introduced clinically in which year? A) 1952 B) 1962 C) 1972 D) 1982 Answer: B

3. Who discovered nalidixic acid? A) Alexander Fleming B) George Lesher C) Paul Ehrlich D) Selman Waksman Answer: B

4. Nalidixic acid was originally identified as a byproduct/distillate during attempted synthesis of: A) Quinine B) Chloroquine C) Primaquine D) Doxycycline Answer: B

5. The original clinical indication for nalidixic acid was: A) Pneumonia B) Urinary tract infections C) Meningitis D) Osteomyelitis Answer: B

6. Quinolones are best described chemically as: A) Beta-lactam ring derivatives B) Synthetic fluorinated analogs of nalidixic acid C) Macrocyclic lactones D) Aminoglycosides Answer: B

Section 2: Classification by Generation

7. Which of the following belongs to the 1st generation fluoroquinolones? A) Ciprofloxacin B) Cinoxacin C) Levofloxacin D) Moxifloxacin Answer: B (also nalidixic acid, oxolinic acid)

8. Which drug is NOT a 2nd generation fluoroquinolone? A) Ciprofloxacin B) Norfloxacin C) Ofloxacin D) Trovafloxacin Answer: D - Trovafloxacin is 4th generation

9. Which of the following is a 3rd generation fluoroquinolone? A) Nalidixic acid B) Gatifloxacin C) Ciprofloxacin D) Clinafloxacin Answer: B (also grepafloxacin, pazufloxacin, tosufloxacin)

10. Which of these is a 4th generation fluoroquinolone? A) Norfloxacin B) Gemifloxacin C) Oxolinic acid D) Enoxacin Answer: B (also clinafloxacin, moxifloxacin, trovafloxacin)

11. Which generation of fluoroquinolones was originally developed primarily for gram-negative aerobic coverage, with limited gram-positive activity? A) 1st generation B) 2nd generation C) 3rd generation D) 4th generation Answer: A

12. Improved activity against S. pneumoniae and staphylococci, along with activity against zoonotic pathogens and mycobacteria, characterizes which generations? A) 1st and 2nd B) 2nd only C) 3rd and 4th D) None of these Answer: C

13. Fleroxacin, lomefloxacin, and rufloxacin belong to which generation? A) 1st B) 2nd C) 3rd D) 4th Answer: B

14. Pazufloxacin and tosufloxacin belong to which generation? A) 1st B) 2nd C) 3rd D) 4th Answer: C

15. Match the generation: Cinoxacin - 1st, Ciprofloxacin - 2nd, Gatifloxacin - 3rd, Trovafloxacin - ? A) 1st B) 2nd C) 3rd D) 4th Answer: D

Section 3: Mechanism of Action

16. Fluoroquinolones are classified as which type of antimicrobial based on their killing action? A) Bacteriostatic B) Bactericidal C) Bacteriolytic only via cell wall D) No direct antibacterial action Answer: B

17. DNA gyrase is also known as: A) Topoisomerase I B) Topoisomerase II C) Topoisomerase III D) Topoisomerase IV Answer: B

18. Inhibition of topoisomerase IV interferes with: A) Transcription initiation B) Separation of replicated chromosomal DNA into daughter cells C) Peptidoglycan cross-linking D) mRNA translation Answer: B

19. The supercoiling state of DNA that gyrase normally relaxes, which fluoroquinolones block, is: A) Negative supercoiling B) Positive supercoiling C) Linear DNA D) Circular plasmid only Answer: B

20. Which bacterial process is directly disrupted first by fluoroquinolone-induced enzyme inhibition, leading to cell death? A) Cell wall synthesis B) DNA replication and transcription C) Folate synthesis D) Protein synthesis at 50S subunit Answer: B

Section 4: Generation-Specific Pharmacology

21. Why are 1st generation quinolones restricted to uncomplicated UTIs? A) High protein binding B) Minimal serum levels achieved C) Excessive CNS penetration D) Rapid renal failure induction Answer: B

22. Typical MICs of 2nd generation fluoroquinolones against gram-negative cocci/bacilli (e.g., Enterobacter, P. aeruginosa, N. meningitidis) are approximately: A) 0.01-0.1 mcg/mL B) 1-2 mcg/mL C) 10-20 mcg/mL D) 100 mcg/mL Answer: B

23. Second generation fluoroquinolones are active against MSSA but NOT reliably against: A) E. coli B) MRSA C) H. influenzae D) Campylobacter jejuni Answer: B

24. Gemifloxacin's special in-vitro property relative to S. pneumoniae is: A) Activity against ciprofloxacin-resistant strains B) Complete resistance to all strains C) No activity against pneumococcus D) Only bacteriostatic activity Answer: A (in-vivo efficacy for this specific property remains unproven per your notes)

25. Trovafloxacin retains notable activity against which organism among 4th generation drugs' distinguishing features? A) Pseudomonas species and anaerobes B) Only gram-positive cocci C) Fungi D) Viruses Answer: A

26. Why is trovafloxacin use restricted to limb- and life-threatening infections requiring inpatient treatment? A) Nephrotoxicity B) Hepatotoxicity C) Ototoxicity D) Bone marrow suppression Answer: B

27. Maximum recommended duration for trovafloxacin therapy per your notes is: A) 3 days B) 7 days C) 14 days D) 30 days Answer: C

Section 5: Antimicrobial Spectrum

28. Compared to nalidixic acid, fluorinated derivatives like ciprofloxacin and levofloxacin show: A) Reduced tissue penetration B) Greater antibacterial activity and bactericidal blood/tissue levels C) No improvement in spectrum D) Loss of gram-negative activity Answer: B

29. The basis for classifying fluoroquinolones into generations is primarily their: A) Molecular weight B) Relative activity against gram-negative versus gram-positive species C) Route of administration D) Color of the tablet Answer: B

30. Nalidixic acid's clinical utility was limited to which site of infection due to poor systemic levels? A) Upper respiratory tract B) Lower urinary tract C) CNS D) Bone Answer: B

Section 6: Mechanisms of Resistance

31. The frequency of spontaneous resistance emergence during fluoroquinolone therapy is approximately: A) 1 in 10²-10³ organisms B) 1 in 10⁷-10⁹ organisms C) 1 in 10¹²-10¹⁵ organisms D) 1 in 100 organisms Answer: B

32. Organisms particularly prone to fluoroquinolone resistance emergence include all EXCEPT: A) Staphylococci B) Pseudomonas aeruginosa C) Serratia marcescens D) Treponema pallidum Answer: D

33. Chromosomal resistance to fluoroquinolones occurs via: A) Point mutations in the quinolone-binding region of the target enzyme B) Beta-lactamase production C) Ribosomal methylation D) Cell wall thickening only Answer: A (also altered membrane permeability)

34. The first described type of plasmid-mediated fluoroquinolone resistance works by: A) Efflux pump overexpression B) Proteins that protect DNA gyrase from the drug (Qnr proteins) C) Enzymatic hydrolysis of the drug D) Altered ribosomal binding site Answer: B

35. The second plasmid-mediated resistance mechanism described involves: A) A variant aminoglycoside acetyltransferase that modifies ciprofloxacin B) A variant beta-lactamase C) A methyltransferase acting on rRNA D) A porin channel deletion Answer: A

36. Plasmid-mediated resistance mechanisms typically confer: A) High-level resistance immediately B) Low-level resistance that facilitates later point mutations causing high-level resistance C) No clinical significance D) Resistance only to beta-lactams Answer: B

37. High-level resistance to one fluoroquinolone generally results in: A) Increased susceptibility to other fluoroquinolones B) Cross-resistance to all other fluoroquinolones C) No change in susceptibility pattern D) Resistance limited to that single drug only Answer: B

Section 7: Pharmacokinetics

38. Oral bioavailability of fluoroquinolones typically ranges from: A) 20-40% B) 50-70% C) 80-95% D) 95-100% with no exceptions Answer: C

39. Serum half-lives of fluoroquinolones range from: A) 30 minutes to 1 hour B) 3 to 10 hours C) 24 to 48 hours D) 1 week Answer: B

40. Oral absorption of fluoroquinolones is impaired by: A) Monovalent cations like sodium B) Divalent and trivalent cations (e.g., in antacids) C) Fat-soluble vitamins D) Beta-blockers Answer: B

41. Correct dosing advice for a patient taking calcium-containing antacids and ciprofloxacin: A) Take together for better absorption B) Take fluoroquinolone 2 hours before or 4 hours after the antacid C) Avoid fluoroquinolones altogether D) Double the fluoroquinolone dose Answer: B

42. Most fluoroquinolones are eliminated primarily by: A) Hepatic metabolism only B) Renal mechanisms (tubular secretion/glomerular filtration) C) Biliary excretion exclusively D) Pulmonary exhalation Answer: B

43. Dosage adjustment of fluoroquinolones is required when creatinine clearance falls below: A) 80 mL/min B) 50 mL/min C) 20 mL/min D) No adjustment ever needed Answer: B

44. CSF penetration of fluoroquinolones is generally described as: A) Excellent, exceeding serum levels B) Limited C) Zero, none crosses the blood-brain barrier D) Only achieved with nalidixic acid Answer: B

Section 8: Drug Interactions

45. Which of the following increases fluoroquinolone levels when co-administered? A) Theophylline B) NSAIDs C) Corticosteroids D) All of the above Answer: D

46. Ciprofloxacin increases the plasma concentration of all of the following EXCEPT: A) Theophylline B) Caffeine C) Warfarin D) Metformin Answer: D

47. A patient on warfarin is started on ciprofloxacin. The expected interaction is: A) Decreased INR, risk of clot B) Increased warfarin levels, risk of bleeding C) No interaction D) Ciprofloxacin levels decrease E) Answer: B - increased warfarin plasma concentration, requires INR monitoring

48. Concurrent NSAID use with fluoroquinolones raises concern primarily for: A) Additive CNS stimulation/seizure risk B) Renal protection C) Improved antibacterial synergy D) No clinically relevant concern Answer: A

49. Fluoroquinolones increase plasma levels of which antidepressant-related agent listed in your notes? A) Fluoxetine B) Imipramine C) Sertraline D) Bupropion Answer: B

50. Antacids and iron salts affect fluoroquinolone pharmacokinetics by: A) Increasing absorption B) Reducing absorption via chelation C) Increasing renal clearance D) No effect Answer: B

Section 9: Clinical Uses

51. Ciprofloxacin is the drug of choice for prophylaxis and treatment of which bioterrorism-related infection? A) Smallpox B) Anthrax C) Plague only D) Botulism Answer: B

52. Which two fluoroquinolones are effective for uncomplicated and complicated UTIs per your notes? A) Nalidixic acid and cinoxacin B) Ciprofloxacin and levofloxacin C) Trovafloxacin and gemifloxacin D) Oxolinic acid and enoxacin Answer: B

53. Ciprofloxacin is highly efficacious for treating which GI condition? A) Peptic ulcer disease B) Acute diarrheal illness due to enteric pathogens C) Inflammatory bowel disease D) Gastroparesis Answer: B

54. "Respiratory fluoroquinolones" used for URTIs and LRTIs include: A) Ciprofloxacin and norfloxacin B) Levofloxacin and moxifloxacin C) Nalidixic acid and oxolinic acid D) Lomefloxacin and pefloxacin Answer: B

55. Fluoroquinolones are highly effective for osteomyelitis mainly due to: A) Poor bone penetration but strong renal excretion B) Excellent bone penetration and oral bioavailability C) IV-only administration requirement D) Selective activity against gram-positive cocci only Answer: B

56. Osteomyelitis treated with fluoroquinolones is primarily caused by which type of organism per your notes? A) Gram-negative bacilli (e.g., Pseudomonas aeruginosa) B) Anaerobic gram-positive cocci C) Fungi D) Viruses Answer: A

57. For diabetic foot infections, which 4th generation fluoroquinolone offers broad activity against both aerobes and anaerobes? A) Ciprofloxacin B) Norfloxacin C) Moxifloxacin D) Nalidixic acid Answer: C

58. Fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) may occasionally be used for treatment of: A) Malaria B) Tuberculosis and atypical mycobacterial infections C) Viral hepatitis D) Fungal meningitis Answer: B

59. Fluoroquinolones may be suitable for eradication of which organism from asymptomatic carriers? A) Streptococcus pyogenes B) Neisseria meningitidis (meningococci) C) Clostridium difficile D) Candida albicans Answer: B

60. Fluoroquinolone prophylaxis is sometimes used in which vulnerable patient population? A) Pregnant women B) Neutropenic cancer patients C) Healthy children D) Elderly with osteoporosis only Answer: B

Section 10: Adverse Effects

61. Common GI adverse effects of fluoroquinolones include all EXCEPT: A) Nausea B) Vomiting C) Diarrhea D) Constipation as the predominant symptom Answer: D (also antibiotic-associated colitis can occur)

62. CNS adverse effects of fluoroquinolones (confusion, insomnia, dizziness, anxiety, seizures) are attributed to: A) Blockade of NMDA receptors B) Displacement of GABA from its receptors C) Serotonin excess D) Dopamine receptor blockade Answer: B

63. A life-threatening ventricular arrhythmia associated with fluoroquinolones is: A) Atrial fibrillation B) Torsades de pointes C) Wolff-Parkinson-White syndrome D) Sinus bradycardia Answer: B - due to QTc interval prolongation

64. Fluoroquinolones may damage growing cartilage causing: A) Irreversible arthropathy B) Reversible arthropathy C) Permanent joint fusion D) Osteoporosis Answer: B

65. Despite arthropathy risk, fluoroquinolones may still be used in cystic fibrosis patients with pseudomonal infection because: A) The risk is entirely eliminated in CF patients B) Benefit outweighs the risk, and arthropathy is reversible C) CF patients are immune to this side effect D) No alternative antibiotics exist Answer: B

66. Fluoroquinolone-associated liver function abnormality typically presents as: A) Severe fulminant hepatic failure in most patients B) Mild, rare elevation in transaminases C) Always requiring liver transplant D) Hyperbilirubinemia predominant pattern Answer: B

67. Photosensitivity has specifically been reported with which two fluoroquinolones in your notes? A) Ciprofloxacin and levofloxacin B) Lomefloxacin and pefloxacin C) Moxifloxacin and gemifloxacin D) Nalidixic acid and cinoxacin Answer: B

Section 11: QTc Prolongation (Focused)

68. Which fluoroquinolones are specifically associated with QTc prolongation per your notes? A) Nalidixic acid, cinoxacin B) Gatifloxacin, levofloxacin, gemifloxacin, moxifloxacin C) Ciprofloxacin, norfloxacin only D) All quinolones equally without exception Answer: B

69. Fluoroquinolones causing QTc prolongation should be avoided or used cautiously in patients with: A) Known QTc prolongation or uncorrected hypokalemia B) Iron deficiency anemia C) Mild seasonal allergies D) Controlled hypertension only Answer: A

70. Class IA antiarrhythmics that increase risk of QTc-related arrhythmia when combined with fluoroquinolones include: A) Lidocaine B) Quinidine and procainamide C) Metoprolol D) Verapamil Answer: B

71. Class III antiarrhythmics that raise QTc risk in combination with fluoroquinolones include all EXCEPT: A) Sotalol B) Ibutilide C) Amiodarone D) Digoxin Answer: D

72. Non-antiarrhythmic drugs that also increase QTc interval and pose risk when combined with QTc-prolonging fluoroquinolones include: A) Erythromycin and tricyclic antidepressants B) Paracetamol and ibuprofen C) Metformin and glipizide D) Loratadine and cetirizine Answer: A

Section 12: Arthropathy, Tendonitis & Pregnancy

73. Fluoroquinolones are not routinely recommended for patients under what age due to arthropathy risk? A) 12 years B) 18 years C) 25 years D) 40 years Answer: B

74. Tendonitis with risk of tendon rupture from fluoroquinolones is more serious in adults due to: A) Risk of tendon rupture B) Guaranteed permanent disability C) Immediate need for amputation D) No real clinical significance Answer: A

75. Risk factors for fluoroquinolone-induced tendonitis include all EXCEPT: A) Advanced age B) Renal insufficiency C) Concurrent steroid use D) Young age with normal renal function Answer: D

76. Fluoroquinolone use in pregnancy is generally: A) First-line and preferred B) Avoided in absence of specific safety data C) Mandatory for all UTIs in pregnancy D) Only contraindicated in the third trimester Answer: B

Section 13: Specific Drug Profiles

77. Ciprofloxacin (brand name Ciproxin) is used for all of the following EXCEPT: A) Urinary tract infections B) Gonorrhea C) Traveler's diarrhea D) Fungal meningitis Answer: D

78. Usual duration of ciprofloxacin therapy per your notes is: A) 1-2 days B) 7-14 days C) 30 days D) 6 months Answer: B

79. Ciprofloxacin is used in diabetic foot infections primarily targeting: A) Candida albicans B) Pseudomonas aeruginosa C) Clostridium tetani D) Herpes simplex virus Answer: B

80. Levofloxacin (brand name Leflox) belongs to which generation? A) 1st B) 2nd C) 3rd D) 4th Answer: C

81. Levofloxacin's spectrum per your notes includes activity against all EXCEPT: A) Gram-negative organisms B) S. aureus including MRSA C) Legionella pneumophila D) Fungal pathogens like Aspergillus Answer: D

82. Levofloxacin is indicated for all of the following EXCEPT: A) Chronic bronchitis and CAP B) Nosocomial pneumonia C) Intra-abdominal infections D) Primary treatment of malaria Answer: D

83. Levofloxacin's activity against Mycobacterium tuberculosis makes it useful as: A) First-line monotherapy for TB B) An adjunct/alternative agent in TB and atypical mycobacterial disease C) Completely ineffective against mycobacteria D) Only for latent TB prophylaxis Answer: B

Total: 83 MCQs covering history, classification, mechanism of action, resistance, pharmacokinetics, drug interactions, clinical indications, adverse effects, QTc prolongation, arthropathy/tendonitis/pregnancy, and individual drug profiles (ciprofloxacin, levofloxacin).

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