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Communications to the Editor |

Fluoroquinolone Pharmacodynamics and Efficacy FREE TO VIEW

Gary V. Doern, PhD; Glenn S. Tillotson, MSc; Arsad A. Karcic, MD; Faroque A. Khan, MB, FCCP
Author and Funding Information

University Hospitals of Iowa Iowa City, IA Fusion MD, Inc. Cheshire, CT; Gary V. Doern, PhD, Director, Clinical Microbiology Laboratories, University Hospitals of Iowa, Iowa City, IA 52242; e-mail: gary-doern@uiowa.edu Nassau County Medical Center East Meadow, NY State University of New York at Stony Brook Stony Brook, NY

Correspondence to: Arsad A. Karcic, MD, Department of Cardiology, Nassau County Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554; e-mail: arsad@aol.com



Chest. 2001;120(1):319-320. doi:10.1378/chest.120.1.319
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Published online

To the Editor:

We were intrigued to see the recent correspondence by Karcic and Khan1regarding ciprofloxacin therapy of pneumococcal infections and to the response by Brown and Harwell.2One of us (G.S.T.) reviewed this topic in 1994–1995 and reported clinical and bacteriologic success rates of 94.1% and 90.0%, respectively, from 34 studies of acute exacerbations of chronic bronchitis (AECB) and community-acquired pneumonia of ciprofloxacin and Streptococcus pneumoniae.3 Analysis of the newer fluoroquinolones reveals slightly higher success rates, but the most important aspect of using these newer class members was alluded to in terms of the application of pharmacodynamics and the selection of resistance. Recent advice from the World Health Organization4and the Declaration of Toronto (September 2000) suggest that such parameters be observed and that the most pharmacodynamically potent class member be used. It is evident that use of antimicrobial agents having marginal pharmacodynamic activity will select for first-step mutants and the loss of another weapon in the fight against bacterial resistance. From the fluoroquinolone perspective, it is vital that one does not merely rank these agents based on minimum inhibitory concentration (MIC), but instead use the free, unbound maximum serum concentration (Cmax):MIC ratio or area under the inhibitory curve (AUIC) against the most likely pathogen in a specific condition (Table 1 ).5 For example, in community-acquired pneumonia, S pneumoniae or Haemophilus influenzae in patients with mild-to-moderate AECB should be the desired microbial targets. Ideally, the chosen agent should be equally potent against both of these pathogens as well as the atypical pathogens. For fluoroquinolone monotherapy in community respiratory infections, we would advise prescribers to use the most pharmacodynamically potent agent in this class.

Table Graphic Jump Location
Table 1. Comparison of Fluoroquinolone Pharmacodynamics*
* 

MIC90 = minimum inhibitory concentration for 90% of isolates.

References

Karcic, AA, Khan, FA (1998) Ciprofloxacin in the treatment of pneumococcal lower respiratory tract infections: does it work?J Islam Med Assoc North Am30,83-89
 
Davies, BI, Maesen, FP, Baur, C Ciprofloxacin in the treatment of acute exacerbations of chronic bronchitis.Eur J Clin Microbiol1986;5,226-231. [PubMed] [CrossRef]
 
Lee, BL, Kimbrough, RC, Jones, SR, et al Infectious complications with respiratory pathogens despite ciprofloxacin therapy.N Engl J Med1991;25,520-521
 
Colville, A, Knowles, M, Large, D, et al Fluoroquinolones in chronic obstructive pulmonary disease [letter]. BMJ. 1994;;308 ,.:1437
 
Bergogne-Berezin, E, Berthelot, G, Even, P, et al Penetration of ciprofloxacin into bronchial secretions.Eur J Clin Microbiol1986;5,197-200. [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1. Comparison of Fluoroquinolone Pharmacodynamics*
* 

MIC90 = minimum inhibitory concentration for 90% of isolates.

References

Karcic, AA, Khan, FA (1998) Ciprofloxacin in the treatment of pneumococcal lower respiratory tract infections: does it work?J Islam Med Assoc North Am30,83-89
 
Davies, BI, Maesen, FP, Baur, C Ciprofloxacin in the treatment of acute exacerbations of chronic bronchitis.Eur J Clin Microbiol1986;5,226-231. [PubMed] [CrossRef]
 
Lee, BL, Kimbrough, RC, Jones, SR, et al Infectious complications with respiratory pathogens despite ciprofloxacin therapy.N Engl J Med1991;25,520-521
 
Colville, A, Knowles, M, Large, D, et al Fluoroquinolones in chronic obstructive pulmonary disease [letter]. BMJ. 1994;;308 ,.:1437
 
Bergogne-Berezin, E, Berthelot, G, Even, P, et al Penetration of ciprofloxacin into bronchial secretions.Eur J Clin Microbiol1986;5,197-200. [PubMed]
 
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