Liu Hans H
Jefferson Medical College, Philadelphia, Pennsylvania, and Bryn Mawr Medical Specialists Association, Bryn Mawr, Pennsylvania, USA.
Curr Ther Res Clin Exp. 2004 May;65(3):225-38. doi: 10.1016/S0011-393X(04)80047-X.
Approximately 4 million cases of community-acquired pneumonia (CAP) occur in the United States each year, with the majority treated on an outpatient basis. The first fluoroquinolones (eg, ciprofloxacin) were used with caution for respiratory tract infections due to limited in vitro activity against common gram-positive pathogens. With the availability of levofloxacin, followed by gatifloxacin and moxifloxacin hydrochloride, which exhibited increased activity against gram-positive organisms, the fluoroquinolones have become a practical choice for the treatment of CAP.
The aim of this review was to compare the respiratory fluoroquinolones in the outpatient management of CAP.
We conducted a search for English-language articles (key terms: fluoroquinolone, levofloxacin, gatifloxacin, moxifloxacin, and pneumonia; years: 1996-2004). Data from published literature were reviewed regarding clinical and microbiologic efficacy and tolerability; pharmacokinetic and pharmacodynamic properties; and drug costs of levofloxacin, gatifloxacin, and moxifloxacin.
The 3 fluoroquinolones reviewed showed comparable clinical and microbiologic efficacy for the treatment of CAP. In general, the fluoroquinolones were well tolerated, although some differences have been reported, including higher rates of gastrointestinal and other adverse events for gatifloxacin and moxifloxacin. Gatifloxacin and moxifloxacin exhibited greater in vitro potency than levofloxacin against Streptococcus pneumoniae. However, levofloxacin achieved a higher serum drug concentration than the other agents, allowing similar attainment of pharmacokinetic and pharmacodynamic targets required for effective treatment.
The respiratory fluoroquinolones provided appropriate first line treatment in select patients with CAP on the basis of their microbiologic and clinical efficacy and their safety profiles.
美国每年约有400万例社区获得性肺炎（CAP）病例，大多数在门诊治疗。第一代氟喹诺酮类药物（如环丙沙星）因对常见革兰氏阳性病原体的体外活性有限，在呼吸道感染治疗中使用时需谨慎。随着左氧氟沙星、加替沙星和盐酸莫西沙星的出现，它们对革兰氏阳性菌的活性增强，氟喹诺酮类药物已成为治疗CAP的实用选择。
本综述旨在比较呼吸道氟喹诺酮类药物在CAP门诊管理中的应用。
我们检索了英文文章（关键词：氟喹诺酮、左氧氟沙星、加替沙星、莫西沙星和肺炎；年份：1996 - 2004年）。回顾了已发表文献中关于临床和微生物学疗效及耐受性、药代动力学和药效学特性以及左氧氟沙星、加替沙星和莫西沙星的药物成本的数据。
所综述的3种氟喹诺酮类药物在治疗CAP方面显示出相当的临床和微生物学疗效。总体而言，氟喹诺酮类药物耐受性良好，尽管有一些差异报道，包括加替沙星和莫西沙星的胃肠道及其他不良事件发生率较高。加替沙星和莫西沙星对肺炎链球菌的体外活性比左氧氟沙星更强。然而，左氧氟沙星的血清药物浓度高于其他药物，能达到有效治疗所需的类似药代动力学和药效学目标。
基于其微生物学和临床疗效以及安全性，呼吸道氟喹诺酮类药物为特定CAP患者提供了合适的一线治疗。
