Comparative efficacy of sparfloxacin in comparison with amoxycillin plus ofloxacin in the treatment of community-acquired pneumonia

Portier, H.; May, T.; Proust, A. J.

doi:10.1093/jac/37.suppl_a.83

Cited by 39 publications

(19 citation statements)

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“…Several randomized, comparative trials of treatment of such patients with the newest quinolones have been published, some of which have also been double-blind in design [69][70][71][72][73]. In each of these trials, clinical outcomes with the quinolones were similar or superior to those with use of comparator agents, for example, for levofloxacin (500 mg iv/po for 7-14 days) versus ceftriaxone (1-2 g iv q.d.…”

Section: Clinical Applicationsmentioning

confidence: 99%

New Uses for New and Old Quinolones and the Challenge of Resistance

Hooper¹

2000

Clinical Infectious Diseases

151

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More than a decade ago ciprofloxacin, the first quinolone with broad indications, was released for clinical use in the United States. The release of ofloxacin, which also had broad applications, followed not long thereafter. Since that time there has been extensive use of these 2 agents and more limited use of other quinolones, such as norfloxacin, enoxacin, and lomefloxacin, which were limited to treatment of infections of the genitourinary tract. Applications of these quinolones largely employed their potent activities against gram-negative bacteria [1,2].This article focuses on information developed in the past 4 years on the 4 most recently released quinolones-levofloxacin, sparfloxacin, grepafloxacin, and trovafloxacin [3-8]-and their spectrum of activity, pharmacokinetics, tolerability, and clinical applications. It also focuses on new applications of the older quinolones. Issues of quinolone resistance related to expanding uses of quinolones will also be discussed. Spectrum of ActivityThe newer fluoroquinolones have retained much of the activity of ciprofloxacin and ofloxacin against enteric gramnegative bacteria, but none is more potent than ciprofloxacin against these pathogens or against Pseudomonas aeruginosa. Levofloxacin is the active stereoisomer of the racemic mixture of the 2 stereoisomers that make up ofloxacin and thus is generally 2-fold more potent than ofloxacin [3]. Trovafloxacin [9] and, to a lesser extent, levofloxacin generally have gram-negative coverage similar to that of ciprofloxacin, but both may be less active against some strains of P. aeruginosa.There may also be gaps in trovafloxacin's coverage of some strains of Providencia species, Proteus species, and Serratia marcescens. There are also gaps in the gram-negative coverage of sparfloxacin and grepafloxacin. Sparfloxacin [10,11] has only limited potency against P. aeruginosa, S. marcescens, Citrobacter freundii, and Proteus vulgaris; and grepafloxacin [12] lacks sufficient activity against P. aeruginosa, S. marcescens, Providencia stuartii, and Acinetobacter baumanii among gram-negative bacteria.Like ciprofloxacin and ofloxacin, the newer agents have excellent potency against genital pathogens, including Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma hominis. Their clinical efficacy in the treatment of genital chlamydial infections may differ, however, as discussed below.Against respiratory pathogens, all of the newer quinolones, such as ciprofloxacin and ofloxacin, are highly potent against Haemophilus influenzae and Moraxella catarrhalis. However, these agents exhibit greater potency than ciprofloxacin and ofloxacin against Streptococcus pneumoniae, with MIC 90 values of 1-2 mg/mL for levofloxacin [13], 0.25-0.5 mg/mL for sparfloxacin [14] and grepafloxacin [15], and 0.12-0.25 mg/mL for trovafloxacin [16]. For this reason, all have been developed for treatment of respiratory tract infections, as discussed below. Other respiratory pathogens, such as Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydia pneum...

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Section: Clinical Applicationsmentioning

confidence: 99%

New Uses for New and Old Quinolones and the Challenge of Resistance

Hooper¹

2000

Clinical Infectious Diseases

151

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“…After further excluding duplicate publications ( Fig. 1), 16 RCTs fulfilling the inclusion criteria were included [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Two were published only as conference proceedings and contact with the authors could not be established [6,13].…”

Section: Resultsmentioning

confidence: 99%

“…concealment [7,8,10,15]. Three were double-blind [12][13][14]. One was a cluster-randomised, crossover trial comparing treatment strategies assigned to hospitals in defined study periods as the unit of randomisation [5].…”

Section: Resultsmentioning

confidence: 99%

“…The trials compared quinolone monotherapy versus ␤-lactam/ macrolide combinations (nine trials) [5,7,8,10,11,13,[16][17][18], quinolone monotherapy versus ␤-lactam/quinolone combinations (three trials) [9,12,14] and macrolide monotherapy versus ␤-lactam/macrolide combinations (four trials) [6,15,19,20]. The specific antibiotic comparisons are detailed in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Two trials reported on mortality (RR = 1.00, 95% 0.69-1.45) [9,14], with an overall mortality in these studies of 8.7% (97/1116 patients), and all three reported on clinical failure (RR = 1.11, 95% CI 0.89-1.38; 1252 patients; Fig. 2) [9,12,14]. There was a significantly higher risk of diarrhoea with the addition of the ␤-lactam in one trial (RR = 2.05, 95% CI 1.13-3.73) [14], with no significant difference in overall discontinuations due to AEs (RR = 1.37, 95% CI 0.87-2.16).…”

Section: Quinolone Versus ˇ-Lactam/quinolonementioning

confidence: 97%

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