Treatment of pneumonia: new strategies for changing pathogens

Changes in the etiologic agents that cause pneumonia pose new challenges for empiric antimicrobial therapy. Ofloxacin is a new oral quinolone antibiotic with good to excellent activity against many of the usual and atypical pulmonary pathogens. Clinical trials have demonstrated high clinical and microbiological cure rates with ofloxacin and comparable efficacy to standard antibiotics used to treat pneumonia. Compared with ciprofloxacin, ofloxacin provides greater bioavailability, extended inhibitory concentrations in the blood, similar activity against gram-negative pathogens, better activity against gram-positive bacteria, in vitro activity against atypical pathogens, renal elimination, and a lower potential for interactions with theophylline and caffeine. These advantages suggest that ofloxacin should be the first-choice quinolone when Staphylococcus aureus is suspected, when higher and prolonged serum and tissue concentrations are needed, and when the patient is also receiving theophylline. In addition, the substitution of a potent oral antibiotic such as ofloxacin for intravenous agents may enable some hospital patients to continue their therapy as outpatients, thus reducing health-care costs.