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Antimicrobial Agents and Chemotherapy, May 2000, p. 1409-1409, Vol. 44, No. 5
0066-4804/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.
LETTERS TO THE EDITOR
Microbiological Efficacy of Levofloxacin for Treatment of
Community-Acquired Pneumonia Due to Chlamydia pneumoniae
 |
LETTER |
Although quinolones have been recommended for treatment of
pneumonia due to Chlamydia pneumoniae (1), data
on the use of these antibiotics for this indication are limited.
Previously published treatment studies of quinolones for
community-acquired pneumonia have used serology for the diagnosis of
C. pneumoniae infection; thus, microbiological efficacy
could not be assessed (1, 4, 5). We obtained nasopharyngeal
specimens for culture of C. pneumoniae from patients, 18 years of age or older, with community-acquired pneumonia who were
enrolled in an open, noncomparative, multicenter study evaluating 500 mg of levofloxacin given intravenously or orally once a day for 7 to 14 days. Cultures were obtained at baseline and 5 to 7 days and 21 to 28 days after treatment. Susceptibility testing of C. pneumoniae was performed in cell culture using HEp-2 cells as
previously described (6). Cultures for C. pneumoniae were obtained from 646 patients; 47 (7.3%) were positive at one or more study visits. C. pneumoniae was
eradicated from the nasopharynx in 16 (80%) of the 20 evaluable
culture-positive patients after treatment. In vitro susceptibility
testing for levofloxacin was performed on eight isolates of C. pneumoniae from these patients. The MICs and minimal bactericidal
concentrations (MBCs) for these isolates ranged from 0.125 to 0.5 µg/ml and were the same at baseline and after therapy (Table
1).
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TABLE 1.
In vitro susceptibilities to levofloxacin of C. pneumoniae isolates from four persistently positive patients with
pneumonia
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These results are comparable to our previous experience with macrolides
for the treatment of C. pneumoniae pneumonia in adults and
children: microbiological efficacy of 79% for clarithromycin, 70 and
83% for azithromycin, and 86% for erythromycin (2, 6). File et al. (4) reported a clinical cure rate of 98% among patients who were treated with levofloxacin compared to 93% of those
treated with ceftriaxone and/or cefuroxime axitil. Erythromycin or
doxycycline could also be added. The response rate of those with
serologic evidence of C. pneumoniae infection did not differ between those patients who had erythromycin or doxycycline added to
their treatment regimen. There was also no difference in the response
rate among those patients who had definite infection, i.e., a fourfold
rise in microfluorescence immunoglobulin G (IgG) or IgM, compared to
those who had probable infection, i.e., a single IgG 
512 or
IgM 32. The apparent success of the cephalosporin regimens,
which have no or poor activity against Chlamydia, should raise questions about the specificity of the serologic criteria. Other
investigators have claimed eradication based entirely on the results of
serology (5).
Persistence of the organism after therapy did not appear to be due to
the development of resistance. We previously demonstrated a fourfold in
increase in MICs of azithromycin in two or seven persistently
culture-positive patients after therapy, but the MICs were still in the
range considered to indicate susceptibility (6). Resistance
to ofloxacin and sparfloxacin has been described with C. trachomatis in vitro after four passages in subinhibitory concentrations of these drugs (3). Unless cultures are done and microbiological efficiacy is assessed, we may never be able to
survey for, or document, the emergence of resistance.
| |
FOOTNOTES |
*
Phone: (718) 245-4075
Fax: (718) 245-2118
E-mail: mhammerschlag{at}pol.net
| |
REFERENCES |
| 1.
|
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Community-acquired pneumonia in adults: guidelines for management.
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Leophonte, P.,
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Antimicrob. Agents Chemother.
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|
| | | | |
Margaret R. Hammerschlag*
Patricia M. Roblin
Department of Pediatrics, Box 49
SUNY Health Science Center at Brooklyn
450 Clarkson Ave.
Brooklyn, New York 11203-2098
|
Antimicrobial Agents and Chemotherapy, May 2000, p. 1409-1409, Vol. 44, No. 5
0066-4804/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.
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