Fluoroquinolones in the management of community-acquired pneumonia in primary care

Abstract

A literature search was conducted to evaluate the pharmacokinetic and pharmacodynamic profile of the respiratory fluoroquinolones (gemifloxacin, levofloxacin and moxifloxacin) and their efficacy and safety in the management of community-acquired pneumonia (CAP). Data show that CAP is a common presentation in primary care practice, and is associated with high rates of morbidity and mortality, particularly in the elderly. Although the causative pathogens differ depending on treatment setting and patient factors, Streptococcus pneumoniae is the primary pathogen in all treatment settings. As a class, the respiratory fluoroquinolones have a very favorable pharmacokinetic and pharmacodynamic profile. Pharmacodynamic criteria suggest that moxifloxacin and gemifloxacin are more potent against S. pneumoniae, which may have the added benefit of reducing resistance selection and enhancing bacterial eradication. The respiratory fluoroquinolones are also generally well tolerated, and are first-line options for outpatient treatment of CAP in patients with comorbidities or previous antibiotic use.

Keywords::

• antimicrobial resistance
• antimicrobials
• community-acquired pneumonia
• fluoroquinolones
• pharmacodynamics
• pharmacokinetics
• primary care

Financial & competing interests disclosure

Brian Wispelwey has served on Speaker’s bureau for Pfizer and Schering-Plough, and ID Net Advisory board for Schering-Plough. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing assistance was utilized in the production of this manuscript. The authors would like to acknowledge the editorial assistance of Ching-Ling Chen, PhD, in the preparation of this manuscript. Support for this assistance was provided by Schering-Plough Corporation. The author accepts full responsibility for the construction and authorship of this manuscript.