The treatment of
respiratory tract infection is the most common reason for
antibiotic prescribing. However, therapeutic options are diminishing as antibiotic resistance to
penicillins and
macrolides in key respiratory pathogens is increasing. As resistance increases, there are parallel rises in the number of treatment failures and the total cost of
infection management. New generation broad-spectrum
fluoroquinolones, such as
grepafloxacin, have recently been recommended as a first-line treatment option in guidelines for lower
respiratory tract infection.
Grepafloxacin is an oral
fluoroquinolone, with a microbiological and clinical profile that is particularly suited to the treatment of community-acquired
respiratory infections. In vitro, it is rapidly bactericidal, and compared with earlier
quinolones, its broad spectrum activity encompasses all important respiratory pathogens; Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella pneumophila, including strains which are resistant to
penicillin, other
beta-lactam antibiotics and
macrolides. In addition,
grepafloxacin achieves high lung concentrations, and its long half-life (up to 15 h) enables once daily dosing. Overall,
grepafloxacin combines the positive properties of the
beta-lactam antibiotics against conventional Gram-positive and Gram-negative respiratory pathogens, with the activity of the
macrolides against atypical pathogens. In patients with bacteriologically documented
infections, clinical studies in community-acquired
pneumonia have shown that treatment for 7-10 days once daily (o.d.) with approximately 600 mg is equivalent to that with either twice daily (b.i.d.)
clarithromycin 250 mg, or three times daily (t.i.d.)
cefaclor 500 mg, and superior to that with t.i.d.
amoxycillin 500 mg. In these studies,
grepafloxacin proved effective in the treatment of both typical and atypical
pneumonia. In acute bacterial exacerbations of
chronic bronchitis (ABECB), 7-10 days treatment with o.d.
grepafloxacin 400 mg or 600 mg has been shown to be equivalent to that with either t.i.d.
amoxycillin 500 mg, or b.i.d.
ciprofloxacin 500 mg. In patients with a documented bacterial pathogen, microbiological success with both
grepafloxacin dosage regimens was superior to
amoxycillin 500 mg t.i.d. In addition, short course treatment of ABECB with 400 mg of
grepafloxacin given o.d. for five days has been shown to be as effective, clinically and microbiologically as a ten-day course of the same dose. The safety profile of
grepafloxacin has been well-characterised from data from over 12,000 patients treated in Phase II/III and post-marketing studies, and over 400,000 patients treated worldwide in routine clinical practice. The most commonly reported adverse events are gastrointestinal, mainly
nausea and unpleasant taste. The potential for photosensitivity and central nervous system effects is low, and there have been no reports of convulsions. No unique or unexpected.