Fluoroquinolones in the Management of Community-acquired Pneumonia in Primary Care

Brian Wispelwey; Katherine R Schafer

Disclosures

Expert Rev Anti Infect Ther. 2010;8(11):1259-1271. 

In This Article

Fluoroquinolone Efficacy against Drug-resistant CAP Pathogens

Resistant pathogens such as DRSP and MDRSP are of great concern in CAP. Approximately 35% of S. pneumoniae clinical isolates are penicillin-resistant, 29.5% are macrolide-resistant, 22.5% are multidrug-resistant and 8% demonstrate high-level resistance to penicillin (≥2 µg/ml).[27,59,60] It is important to note, however, that β-lactam resistance does not necessarily correlate with worse clinical outcomes. As discussed earlier, in vitro resistance can be difficult to interpret and does not rule out the use of macrolides or β-lactams.[13] Gemifloxacin is bactericidal against both low-level (MIC 4 mg/l) and high-level (MIC 16 mg/l) ciprofloxacin-resistant S. pneumoniae. Moxifloxacin and levofloxacin are bactericidal for low-level resistant strains.[61]

Fluoroquinolone resistance in common CAP pathogens has been noted. Worldwide, ciprofloxacin resistance rates rose from 1.5% in 1999 to 6.8% in 2001.[45] High rates of levofloxacin use in particular geographic regions have been associated with increased fluoroquinolone resistance in pneumococci.[62] Increased use of moxifloxacin has been associated with an increase in fluoroquinolone resistance in Gram-negative pathogens.[63] In an in vitro pharmacodynamic study, both moxifloxacin and levofloxacin were effective against multiple strains of S. pneumoniae, including one wild type, two first-step parC mutants and one pump mutant.[64]

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