Fluoroquinolones in the management of community-acquired pneumonia

• Published in: International journal of clinical practice (Esher) Vol. 64; no. 3; pp. 378 - 388
• Main Authors: Albertson, T. E., Dean, N. C., El Solh, A. A., Gotfried, M. H., Kaplan, C., Niederman, M. S.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.02.2010; Wiley-Blackwell; Hindawi Limited
• Subjects: Anti-Bacterial Agents - pharmacokinetics; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Community-Acquired Infections - drug therapy; Community-Acquired Infections - metabolism; Drug therapy; Fluoroquinolones - pharmacokinetics; Fluoroquinolones - therapeutic use; General aspects; Humans; Medical sciences; Pharmacology. Drug treatments; Pneumonia; Pneumonia, Bacterial - drug therapy; Pneumonia, Bacterial - metabolism; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Risk Factors; Streptococcus pneumoniae; Treatment Outcome; Medicine; Lung disease; Fluoroquinolone derivatives; Pneumonia; Clinical management; Community acquired infection; Respiratory disease; Antibacterial agent
• ISSN: 1368-5031; 1742-1241
• DOI: 10.1111/j.1742-1241.2009.02239.x

Summary Aims:  Review of the current guidelines for the use of respiratory fluoroquinolones in the management of community‐acquired pneumonia (CAP). Methods:  Data were collected from recent clinical trials on fluoroquinolone therapy in patients with CAP and from updated recommendations of antimicrobial therapy in managing CAP, with a focus on current North American guidelines. Results:  Randomised clinical trials of respiratory fluoroquinones (moxifloxacin, levofloxacin and gemifloxacin) in the treatment of CAP were identified and analysed. The bacteriology of CAP, and susceptibility rates, resistance rates and pharmacokinetic and pharmacodynamic properties of fluoroquinolones against causative pathogens in CAP, and adverse event profiles of these agents were described. Respiratory fluoroquinones have broad‐spectrum antibacterial activities against common causative pathogens in CAP and provide an important treatment option as monotherapy for outpatients with comorbidities and inpatients who are not admitted to the intensive care unit (ICU), including those with risk factors of drug‐resistant Streptococcus pneumoniae. For treatment of ICU patients with severe CAP, it is recommended that fluoroquinolones be used in combination with a β‐lactam. Recent studies also demonstrated a more rapid resolution of clinical symptoms with the use of highly potent respiratory fluoroquinolones. Discussion:  Appropriate use of fluoroquinolone agents may shorten the duration of antimicrobial therapy and the length of hospital stay and contribute to the decreased development of resistance in patients with CAP. Adverse event profiles of these agents should be considered to facilitate the selection of an appropriate fluoroquinolone for appropriate CAP patients. Conclusion:  The fluoroquinolone class, specifically those with adequate activity against respiratory pathogens, represents an important and convenient treatment option for patients with CAP.