Because of their antimicrobial activity and pharmacologic properties,
fluoroquinolones should be particularly suitable for the treatment of lower
respiratory tract infections, although they might be less efficient in
pneumococcal diseases. In fact, the overall clinical success rate of
enoxacin,
ofloxacin,
pefloxacin, and
ciprofloxacin is greater than 85%, and their efficacy compares favorably with that of other
antibiotics. For acute exacerbation of
chronic bronchitis, however,
beta-lactam or
macrolide agents probably remain a first choice unless sputum reveals gram-negative pathogens; in the same way, drugs other than
quinolones seem better indicated in community-acquired
pneumonia because of the prevalence of Streptococcus pneumoniae in these
infections. In contrast, nosocomial pulmonary
infections due to gram-negative pathogens should be excellent candidates for
therapy with new
quinolones. These drugs, used with or without
erythromycin and
rifampin, might be useful in the treatment of
legionnaires' disease.