In recent years,
fluoroquinolone research has focused on achieving several goals, including (1) enhanced potency against gram-positive cocci, notably Streptococcus pneumoniae, and anaerobes, while (2) maintaining potency against gram-negative pathogens, (3) optimizing pharmacokinetics and pharmacodynamics (PK/PD), and (4) minimizing potential
adverse drug reactions through recognition and avoidance of structural configurations that have characterized earlier, reactive compounds.
OBJECTIVE: The newer
fluoroquinolones have fulfilled many of the research goals described above.
Levofloxacin has improved anti-gram-positive potency, PK/PD properties, a proven clinical trial record (particularly for communityacquired
pneumonia [CAP]), and an excellent safety profile-in the context of the treatment of >250 million patients worldwide in the past decade. It is licensed for management of
drug-resistant S pneumoniae
infections in the United States and has gained widespread formulary acceptance and guideline inclusion. Studies assessing
levofloxacin for CAP
therapy show significant advantages over standard
therapy, such as trends toward reduced IV
therapy and length of hospitalization, reduced mortality, and significant associated cost reduction. In addition,
levofloxacin has proved highly effective in acute exacerbations of
chronic bronchitis (AECB), with excellent clinical and bacteriologic results, typical of the class, and significant advantages-in terms of clinical response, overall pathogen eradication, extension of the symptom-free period, and trends toward a reduction in the number of consultation visits and hospitalizations-over standard agents, such as the oral
cephalosporins.
CONCLUSIONS: