About: Guide to Selection of Fluoroquinolones in Patients with Lower Respiratory Tract Infections

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An Entity of Type : schema:ScholarlyArticle, within Data Space : covidontheweb.inria.fr associated with source document(s)

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type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
title	Guide to Selection of Fluoroquinolones in Patients with Lower Respiratory Tract Infections
Creator	Evans, Martin Shams, Wael
source	Medline; PMC
abstract	Newer fluoroquinolones such as levofloxacin, moxifloxacin, gatifloxacin and gemifloxacin have several attributes that make them excellent choices for the therapy of lower respiratory tract infections. In particular, they have excellent intrinsic activity against Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and the atypical respiratory pathogens. Fluoroquinolones may be used as monotherapy to treat high-risk patients with acute exacerbation of chronic bronchitis, and for patients with community-acquired pneumonia requiring hospitalisation, but not admission to intensive care. Overall, the newer fluoroquinolones often achieve clinical cure rates in ≥90% of these patients. However, rates may be lower in hospital-acquired pneumonia, and this infection should be treated on the basis of anticipated organisms and evaluation of risk factors for specific pathogens such as Pseudomonas aeruginosa. In this setting, an antipseudomonal fluoroquinolone may be used in combination with an antipseu-domonal β-lactam. Concerns are now being raised about the widespread use, and possibly misuse, of fluoroquinolones and the emergence of resistance among S. pneumoniae, Enterobacteriaceae and P. aeruginosa. A number of pharmacokinetic parameters such as the peak concentration of the antibacterial after a dose (C(max)), and the 24-hour area under the concentration-time curve (AUC(24)) and their relationship to pharmacodynamic parameters such as the minimum inhibitory and the mutant prevention concentrations (MIC and MPC, respectively) have been proposed to predict the effect of fluoroquinolones on bacterial killing and the emergence of resistance. Higher C(max)/MIC or AUC(24)/MIC and C(max)/MPC or AUC(24)/MPC ratios, either as a result of dose administration or the susceptibility of the organism, may lead to a better clinical outcome and decrease the emergence of resistance, respectively. Pharmacokinetic profiles that are optimised to target low-level resistant minor subpopulations of bacteria that often exist in infections may help preserve fluoroquinolones as a class. To this end, optimising the AUC24/ MPC or Cmax/MPC ratios is important, particularly against S. pneumoniae, in the setting of lower respiratory tract infections. Agents such as moxifloxacin and gemifloxacin with high ratios against this organism are preferred, and agents such as ciprofloxacin with low ratios should be avoided. For agents such as levofloxacin and gatifloxacin, with intermediate ratios against S. pneumoniae, it may be worthwhile considering alternative dose administration strategies, such as using higher dosages, to eradicate low-level resistant variants. This must, of course, be balanced against the potential of toxicity. Innovative approaches to the use of fluoroquinolones are worth testing in further in vitro experiments as well as in clinical trials.
has issue date	2012-09-19(xsd:dateTime)
bibo:doi	10.2165/00003495-200565070-00004
bibo:pmid	15892589
has license	no-cc
sha1sum (hex)	11a5e6ef8d4c839c60d9a530b8181f4d28a1385f
schema:url	https://doi.org/10.2165/00003495-200565070-00004
resource representing a document's title	Guide to Selection of Fluoroquinolones in Patients with Lower Respiratory Tract Infections
has PubMed Central identifier	PMC7100689
has PubMed identifier	15892589
schema:publication	Drugs
resource representing a document's body	covid:11a5e6ef8d4c839c60d9a530b8181f4d28a1385f#body_text
is schema:about of	named entity 'FLUOROQUINOLONES' named entity 'SELECTION' named entity 'PATIENTS' named entity 'LOWER RESPIRATORY TRACT INFECTIONS' named entity 'GUIDE' »more»

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