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Respiratory infections: clinical experiences with the new quinolones
1Department of Medical Microbiology, De Wever Ziekenbuis, Heerlen, The Netherlands.
Abstract:
Nearly 300 patients, admitted to hospital with acute purulent exacerbations of chronic respiratory disease, have been treated with various newer quinolones: 26 patients received enoxacin, 50 pefloxacin, 80 ciprofloxacin and 143 ofloxacin. Dosages varied from 400 mg once daily to 1000 mg twice daily. orally for five to 10 days. Patients were evaluated bacteriologically and clinically before, during and after treatment. Nearly all infections associated with Haemophilus influenzae and/or Branhamella catarrhalis were successfully eradicated. Some Streptococcus pneumoniae infections relapsed, some could not be eradicated, and a number of patients developed new infections with these organisms. Approximately half of the Pseudomonas aeruginosa infections were eradicated. Nearly all patients received concomitant theophylline but this only caused serious problems in those given 600 mg doses of enoxacin twice daily. Five patients given ciprofloxacin had to discontinue because of unwanted effects (mostly hallucinations), one patient given pefloxacin had gastric pain and two patients given ofloxacin developed a skin rash. Apart from the theophylline interaction, the unwanted effects did not appear to be dose-related. The best overall clinical results were noted after 800 mg doses of ofloxacin once daily for seven days.
Insights
Newer quinolones effectively treat acute purulent exacerbations of chronic respiratory disease, eradicating most Haemophilus influenzae and Branhamella catarrhalis infections. Ofloxacin at 800 mg daily showed the best clinical results with manageable side effects.
Area of Science:
- Infectious Diseases
- Pharmacology
- Respiratory Medicine
Background:
- Acute purulent exacerbations of chronic respiratory disease (APCD) are common and require effective antimicrobial therapy.
- Newer quinolone antibiotics offer potential treatment options for bacterial respiratory infections.
Purpose of the Study:
- To evaluate the efficacy and safety of various newer quinolones in treating APCD.
- To compare the clinical outcomes and side effect profiles of enoxacin, pefloxacin, ciprofloxacin, and ofloxacin.
Main Methods:
- A study involving nearly 300 hospitalized patients with APCD treated with enoxacin, pefloxacin, ciprofloxacin, or ofloxacin.
- Bacteriological and clinical evaluations were performed before, during, and after a 5-10 day oral treatment course.
- Dosages varied, with concomitant theophylline use monitored for interactions.
Main Results:
- High eradication rates for Haemophilus influenzae and Branhamella catarrhalis infections.
- Variable efficacy against Streptococcus pneumoniae and Pseudomonas aeruginosa, with some relapses and new infections observed.
- Ofloxacin 800 mg once daily for seven days yielded the best clinical results.
- Adverse effects were generally mild, except for a significant interaction between enoxacin and theophylline; ciprofloxacin caused hallucinations in some patients.
Conclusions:
- Newer quinolones are effective against common pathogens in APCD, particularly H. influenzae and B. catarrhalis.
- Ofloxacin demonstrates promising efficacy and a favorable clinical outcome profile.
- Careful monitoring for drug interactions, especially with theophylline, and patient-specific side effects is crucial.