Ferrara A M
Dipartimento di Scienze Ematologiche, Pneumologiche, Cardiovascolari Mediche e Chirurgiche, Sezione di Pneumologia, Padiglione Forlanini, Viale Taramelli 5, 27100 Pavia, Italy.
Infection. 2005 Jun;33(3):106-14. doi: 10.1007/s15010-005-4102-8.
The increasing resistance of Streptococcus pneumoniae, the most important community respiratory pathogen, to beta-lactams and other first-line antimicrobial agents usually employed for the empirical treatment of lower respiratory tract infections has led to the inclusion, in several current guidelines, of a fluoroquinolone with improved activity against pneumococci as the first choice agent for the management of such infections. The excellent microbiological, pharmacokinetic, and pharmacodynamic characteristics of the new fluoroquinolones (levofloxacin, moxifloxacin, gemifloxacin, and gatifloxacin) have encouraged their growing use, probably contributing to the emergence of fluoroquinolone-resistant pneumococci; although pneumococcal resistance to new fluoroquinolones is currently low, there is still concern about the potential for widespread emergence of resistance to these agents if they become indiscriminately used. Levofloxacin clinical failures have already been reported in the management of patients with pneumococcal community-acquired pneumonia; development of resistance in clinical isolates of S. pneumoniae has prompted a critical reexamination of the newer fluoroquinolones to assess their potency and to preserve their activity. An understanding of the pharmacokinetic and pharmacodynamic properties, allowing selection of the most potent fluoroquinolone, will reduce the opportunity for resistance to develop. Finally, a targeted use of these agents will maintain class efficacy.
肺炎链球菌是最重要的社区呼吸道病原体，其对β-内酰胺类及其他常用于下呼吸道感染经验性治疗的一线抗菌药物的耐药性不断增加，这使得在一些现行指南中，将对肺炎球菌活性有所提高的氟喹诺酮类药物列为这类感染治疗的首选药物。新型氟喹诺酮类药物（左氧氟沙星、莫西沙星、吉米沙星和加替沙星）出色的微生物学、药代动力学和药效学特性促使其使用日益广泛，这可能导致了对氟喹诺酮耐药的肺炎球菌的出现；尽管目前肺炎球菌对新型氟喹诺酮类药物的耐药率较低，但如果不加区分地使用这些药物，仍担心耐药性可能会广泛出现。在肺炎球菌社区获得性肺炎患者的治疗中，已经报道了左氧氟沙星治疗失败的情况；肺炎链球菌临床分离株中耐药性的出现促使对新型氟喹诺酮类药物进行严格的重新评估，以评估其效力并保持其活性。了解药代动力学和药效学特性，从而选择最有效的氟喹诺酮类药物，将减少耐药性产生的机会。最后，有针对性地使用这些药物将维持该类药物的疗效。
