In view of their antimicrobial activity and pharmacological properties,
fluoroquinolones should be suitable for the treatment of lower
respiratory tract infections. The overall clinical success rate using
enoxacin,
ofloxacin,
pefloxacin, and
ciprofloxacin ranges from 81% to 89%. Despite relatively high MICs of the
fluoroquinolones for Streptococcus pneumoniae, the clinical success rate of these drugs in
pneumococcal infections is 91%, but the eradication rate of this pathogen is lower (73%). In addition,
fluoroquinolones appeared to be as effective as standard
antibiotic regimens for treatment of bronchopulmonary
infections in most of the comparative trials reported. The new
quinolones could be a good alternative for treatment of acute exacerbations of
chronic bronchitis, especially if examination of the sputum reveals gram-negative pathogens. In community-acquired
pneumonia, drugs other than
quinolones seem indicated because of the limited efficacy of the new
quinolones in the treatment of severe
pneumococcal infections and the poor activity of these drugs against the anaerobic flora causing
aspiration pneumonia. In contrast, new
quinolones should be very suitable for treatment of nosocomial pulmonary
infections due to gram-negative pathogens.
Quinolones used with or without
erythromycin and
rifampin, might be useful in the treatment of
Legionnaires' disease. The role of these drugs in treatment of Chlamydia and Rickettsiae
infections remains to be defined.