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

Expert Commentary

Community-aquired pneumonia is associated with a high degree of morbidity and mortality, and the initial diagnosis and treatment decision, which usually lies with the PCP, is crucial. Although rapid treatment initiation (≤4 h, as per IDSA guideline recommendations) is of utmost importance, antibiotic therapy should only be initiated after a correct diagnosis is established. This helps ensure that a patient will not receive unnecessary treatment and can also help prevent the emergence of drug-resistant organisms. The respiratory fluoroquinolones (levofloxacin, moxifloxacin and gemifloxacin) are recommended by the IDSA/ATS for the treatment of CAP complicated by comorbidities or penicillin allergy. All three fluoroquinolones have high antimicrobial activity and good pharmacokinetic and pharmacodynamic profiles against S. pneumoniae, the most common cause of CAP. In addition, both moxifloxacin and levofloxacin have efficient penetration into the site of infection. Although fluoroquinolone resistance in common CAP pathogens have been reported, studies show that moxifloxacin and levfloxacin are effective against resistant strains of S. pneumoniae. Overall, the fluoroquinolones have been shown to be safe and effective in patients with CAP, either as monotherapy or in combination with other antibiotics. Furthermore, clinical studies have shown that by increasing dosage, therapy duration may be shortened from 10 to 5 days without sacrificing efficacy or safety, which may improve medication compliance while shortening drug exposure.

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