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

Conclusion

Community-aquired pneumonia is a common infection associated with a high degree of morbidity and mortality. PCPs play a pivotal role in the selection of site-of-care, diagnostic testing and empirical antimicrobial treatment of this disease. Specific causative pathogens for CAP are identified in patients who are treated in outpatient clinics, hospital settings or ICUs; S. pneumoniae is the most common pathogen in all three patient populations. CAP treatment strategies vary among these groups, and outcomes of therapy are influenced by age, comorbid conditions and severity of disease. Respiratory fluoroquinolones –moxifloxacin, gemifloxacin and levofloxacin (750 mg) – are recommended for outpatients with comorbidities, immunosuppressing conditions or previous antibiotic use. The respiratory fluoroquinolones demonstrate high bactericidal activity against S. pneumoniae and exhibit broad-spectrum activities against Gram-positive, Gram-negative and atypical pathogens identified in patients with CAP. Fluoroquinolones have proved effective against drug-resistant CAP pathogens, such as DRSP and MDRSP, but the in vitro resistance profiles of pathogens do not necessarily correlate with in vivo resistance, so first-line therapies (macrolides and doxycycline) may still be effective.

The fluoroquinolones also offer good pharmacokinetic and pharmacodynamic profiles that provide advantages in CAP therapy. Their efficient penetration into lung tissue, alveolar cells and ELF result in high clinical and bacteriologic success rates. Pharmacodynamic criteria suggest that moxifloxacin and gemifloxacin are more potent against S. pneumoniae, the leading cause of CAP. This increased potency may lead to faster microbial killing rates, thereby shortening the time to symptom resolution.

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