Pneumonia fluoroquinolones

Higher dose amoxicillin, amoxicillin-davulanate (eg., 90 mg/kg/day) is used for penicillin-resistant Streptococcus pneumoniae fluoroquinolones are avoided in pediatric patients because of the potential for cartilage damage however, their use in pediatrics is emerging. Doses shown are extrapolated from adults and will require further study. 

Fluoroquinolones in the treatment of pneumonia in elderly patients 99MI34. 

Complicated exacerbation FEV, less than 50% predicted Comorbid cardiac disease Greater than or equal to 3 exacerbations per year Antibiotic therapy in the previous 3 months Above organisms plus drug-resistant pneumococci, P-lactamase-producing H. influenzae and M. catarrhalis, Escherichia coli, Proteus spp., Enterobacter spp., Klebsiella pneumoniae Oral P-Lactam/P-Iactamase inhibitor (amoxicil 1 i n-clavulanate) Fluoroquinolone with enhanced pneumococcal activity (levofloxacin, gemifloxacin, moxifloxacin) Intravenous P-Iactam/P-Iactamase inhibitor (ampicillin-sulbactam) Second- or third-generation cephalosporin (cefuroxime, ceftriaxone) Fluoroquinolone with enhanced pneumococcal activity (levofloxacin, moxifloxacin)... 

Community-acquired pneumonia Health care-associated, ventilator-asociated, or nosocomial pneumonia (Early onset no risk factors for MDR pathogens) Third-generation cephalosporin plus a macrolide or doxycycline Third-generation cephalosporin OR Fluoroquinolone OR Ampicillin-sulbactam OR Ertapenem... 

Health care-associated, ventilator-associated, or nosocomial pneumonia (Late onset and/or MDR pathogen risk factors) Antipseudomonal penicillin OR Antipseudomonal cephalosporin OR Antipseudomonal carbapenem plus Aminoglycoside OR Antipseudomonal fluoroquinolone plus Vancomycin or linezolid... 

Treatment for septic patients with hospital-acquired, ventilator-acquired, and health care-associated pneumonia is dependent on risk factors for multi-drug resistant (MDR) organisms (Fig. 79-2). Recommended treatment for patients with no MDR risk factors are third-generation cephalosporins, fluoroquinolones, ampicillin-sulbactam, or ertapenem (see Table 79-3).35 Recommended treatment for patients with MDR risk factors are P-lactam/p-lactamase inhibitors (piperacillin-tazobactam), antipseudomonal cephalosporin, or carbapenem, plus an aminoglycoside, plus vancomycin or linezolid (see Table 79-3).35 If an aminoglycoside is undesirable, a antipseudomonal fluoroquinolone may be utilized with a P-lactam/p-lactamase inhibitor. 

Trimethoprim-sulfamethoxazole, cefuroximej azithromycin, clarithromycin,b or fluoroquinolone Klebsiella pneumoniae... 

M. pneumoniae, if suspected by history or positive cold agglutinins (titers greater than or equal to 1 32) or if confirmed by culture or serology, may be treated with azithromycin. Also, a fluoroquinolone with activity against these pathogens (levofloxacin) may be used in adults. 

Alcoholism Aspiration pneumonia Pneumococcus, K pneumoniae, S. aureus, H influenzae, possibly mouth anaerobes Ticarcillin-clavulanate, piperacillin-tazobactam, plus aminoglycoside carba-penem,e fluoroquinolone ... 

Nosocomial pneumonia Gram-negative bacilli (such as K pneumoniae, Enterobacter spp.. Pseudomonas aeruginosa), 5. aureus Pi peraci 11 i n-tazo bacta rr carbapenem,e or extended-speclrum cephalosporin plus aminoglycoside, fluoroquinolone ... 

See section on treatment of bacterial pneumonia. Macrolide/azalide erythromycin, clarithromycin, azithromycin. cTetracydine tetracycline hydrochloride, doxycydine. Cephalosporin cefuroxime, ceftriaxone, cefotaxime. eCarbapenem imipenem-cilastatin, meropenem. Fluoroquinolone ciprofloxacin, gatifloxacin, or levofloxacin. 

Factors that may decrease theophylline clearance and lead to reduced dosage requirements include advanced age, bacterial or viral pneumonia, heart failure, liver dysfunction, hypoxemia from acute decompensation, and use of drugs such as cimetidine, macrolides, and fluoroquinolone antibiotics. 

Olsen, K.M., Gentry-Nielsen, M., Yue, M., Snitily, M.U. and Preheim, L.C. (2006) Effect of ethanol on fluoroquinolone efficacy in a rat model of pneumococcal pneumonia. Antimicrobial Agents and Chemotherapy, 50, 210-219. 

It is the levoisomer of ofloxacin and having better activity than ciprofloxacin and ofloxacin against S. pneumoniae. It is also used in chronic bronchitis, sinusitis, pyelonephritis, and other related infections of soft tissues. Due to high oral bioavailability, patient can be shifted from IV to oral therapy. It can be administered just once a day regimen as an alternate to other fluoroquinolones in the treatment of respiratory infections. 

Levofloxacin, gatifloxacin, gemifloxacin, and moxifloxacin, so-called respiratory fluoroquinolones, with their enhanced gram-positive activity and activity against atypical pneumonia agents (eg, chlamydia, mycoplasma, and legionella), are effective and used increasingly for treatment of upper and lower respiratory tract infections. 

Streptococcus pneumoniae Arthritis otitis pneumonia sinusitis If penicillin sensitive ampicillin or penicillin G or V If penicillin resistant vancomycin rifampin A cephalosporin erythromycin azithromycin clarithromycin imipenem meropenem a fluoroquinolone trimethoprim-sulfamethoxazole... 

Other Microorganisms Chlamydia pneumoniae Pneumonia Doxycycline Azithromycin clarithromycin erythromycin a fluoroquinolone... 

Mycoplasma pneumoniae Atypical pneumonia Azithromycin, clarithromycin, or erythromycin Doxycycline or a fluoroquinolone... 

Correct answer = B. The fluoroquinolones do not have sufficient activity against S- pneumoniae to be effective. Since they are not p-lac-tams, the fluoroquinolones are effective in treating UTIs caused by p-lactamase-producing organisms. Fluoroquinolones are also indicated for treatment of the other infections listed. 

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