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Antimicrobial Agents and Chemotherapy, June 2003, p. 1790-1797, Vol. 47, No. 6
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.6.1790-1797.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Susceptibilities to Levofloxacin in Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis Clinical Isolates from Children: Results from 2000-2001 and 2001-2002 TRUST Studies in the United States

James A. Karlowsky,1* Clyde Thornsberry,2 Ian A. Critchley,1 Mark E. Jones,3 Alan T. Evangelista,4 Gary J. Noel,5,6 and Daniel F. Sahm1

Focus Technologies, Herndon, Virginia 20171,1 Focus Technologies, Franklin, Tennessee 37064,2 Focus Technologies, 1217 KP Hilversum, The Netherlands,3 Ortho-McNeil Pharmaceutical, Raritan, New Jersey 08869,4 Johnson and Johnson Pharmaceutical Research and Development, Raritan, New Jersey 08869,5 University of Medicine and Dentistry of New Jersey, Newark, New Jersey 071036

Received 8 November 2002/ Returned for modification 22 February 2003/ Accepted 7 March 2003

Among respiratory tract isolates of Streptococcus pneumoniae from children, resistance to penicillins, cephalosporins, macrolides, and trimethoprim-sulfamethoxazole (SXT) increases on an annual basis. Pediatric patients who do not respond to conventional therapy for respiratory tract infections someday may be treated with fluoroquinolones. In this study, MICs of ß-lactams, azithromycin, SXT, and levofloxacin were determined and interpreted by using NCCLS guidelines for isolates of S. pneumoniae (2,834 from children and 10,966 from adults), Haemophilus influenzae (629 from children and 2,281 from adults), and Moraxella catarrhalis (389 from children and 1,357 from adults) collected during the 2000-2001 and 2001-2002 respiratory illness seasons in the United States as part of the ongoing TRUST surveillance studies. Rates of resistance to penicillin, azithromycin, and SXT were >=7.5% higher among patients <=4 years old than among patients 5 to 10, 11 to 17, and >=18 years old in both the 2000-2001 and the 2001-2002 respiratory illness seasons. Levofloxacin resistance was detected in 2 of 2,834 isolates (0.07%) from patients <18 years old. Levofloxacin MICs of 0.25 to 1 µg/ml accounted for 99.6, 99.5, 99.3, 99.7, 98.4, and 98.0% of isolates from patients <2, 2 to 4, 5 to 10, 11 to 17, 18 to 64, and >64 years old. Multidrug resistance was twice as common among patients <=4 years old (25.3%) as among patients 5 to 10 years old (13.7%), 11 to 17 years old (11.9%), 18 to 64 years old (12.1%), and >64 years old (12.4%). The most common multidrug resistance phenotype in S. pneumoniae isolates for all age groups was resistance to penicillin, azithromycin, and SXT (70.3 to 76.6%). For H. influenzae and M. catarrhalis isolates from patients <2, 2 to 4, 5 to 10, 11 to 17, 18 to 64, and >64 years old, levofloxacin MICs at which 90% of the isolates were inhibited were 0.015 and 0.03 to 0.06 µg/ml, respectively, in the 2000-2001 and 2001-2002 respiratory illness seasons. In the 2000-2001 and 2001-2002 respiratory illness season surveillance studies in the United States, 99.9% of pediatric isolates of S. pneumoniae were susceptible to levofloxacin. If fluoroquinolones become a treatment option for pediatric patients, careful monitoring of fluoroquinolone susceptibilities will be increasingly important in future surveillance studies.

* Corresponding author. Mailing address: Focus Technologies, 13665 Dulles Technology Dr., Suite 200, Herndon, VA 20171-4603. Phone: (703) 480-2575. Fax: (703) 480-2654. E-mail: jkarlowsky{at}focusanswers.com.

Antimicrobial Agents and Chemotherapy, June 2003, p. 1790-1797, Vol. 47, No. 6
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.6.1790-1797.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



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