New Role of Quinolones in Respiratory Tract Infections

Abstract

New role of quinolones in respiratory tract infectionsRonald F Grossman MD FRCPC FACP FCCP RF Grossman. New role of quinolones in respiratory tract infections. Can J Infect Dis I 998;9(Suppl E):35E-40E.Because of limited activity of the standard quinolones such as ciprofloxacin and ofloxacin against some clinically imponanr organisms includingStreptococrns pneumoniae and methicillin-resistantStap/rylococcus aureus, new quinolones have been developed. In addition to their improved activity againstS pnewnoniae, some also demonstrate excellent anaerobic activity. None of the quinolones have a role to play in the treatment of paediatric infections. Quinolones (both older and newer agents) have demonstrated equ iva lent efficacy to standard antimicrobials in the treatment of acute sinusitis. Several groups have suggested that quinolones are excellent agents in the treatment of high risk patients with acute exacerbations of chronic bronchitis. These patients include the elderly, and those with frequent exacerbations, significant co morbid conditions. long duration of chron ic bronchitis and major impairment of lung function. There is no evidence to suggest that the newer quinolones wi ll differ from the currently available agents for th is disease. The major advantage of the newer quinolones appears to be in the treatment of patients with community-acquired pneumonia where pneumococcal infection is a real concern. A new parenteral quinolone with pneumococcal activi ty may replace the standard macrolide/cephalosporin comb ination that is com monly prescribed. For patients with nosocomial pneumonia, the newer agents are alternative choices, especially among patients with ea rly onset pneumonia (less than five days of hospitalization), but are unlikely to replace ciprofloxacin in the intensive care unit setting because of poor Pseudomonas aeniginosa coverage. Key Words: Anaerobic activity, Nosocomial pneumonia, QuinolonesLe nouveau role des quinolones dan s les infections respiratoires RESUME: Compte tenu de l'activite limitee des quinolones classiques, comme la ciprofloxacine et l'ofloxacine, contre certa ins organ ismes pathogenes cliniquement import.ants, dont Streptococcus pneumoni(/1 et les souches de Staphylococcus aureus methicillino-resistantes, de nouvelles quinolones one ete mises au point. En plus d'une activite accrue con ere s. pneumoni(l1, certaines manifestent egalement une excellence activite contre les anaerobies. Aucune des quinolones ne joue un role dans le traitemenl des infections pediatriques. Les quinolones, rant anciennes que nouvelles, ont fait preuve d'une efficacite eq uivalence a celle des antimicrobiens ordinaires dans le traitement de la sinusite aigue. Selon plusieurs groupes, les quinolones sont d'excellents agents chez les patients a haut risque souffrantd·exacerbation aigue de bronchite chroniq ue. Ces patients sont les gens ages, ceux dont les exacerbations sont frequentes, ceux qui presentent des comorb idites significatives, ceux dont la bronchite chronique dure depuis longtemps et qu...