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Levofloxacin in the Treatment of Multi-Drug Resistant Streptococcus pneumoniae

Burke A. Cunha, MD
Chief, Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA
Professor of Medicine, State University of New York School of Medicine, Stony Brook, NY, USA

This article reviews antibiotic resistance to Streptococcus pneumoniae and its relevance to the treatment of community-acquired pneumonia (CAP). Antibiotic resistance to S. pneumoniae has become a concern worldwide. Recent literature documents increasing penicillin, macrolide, and trimethoprim-sulfamethoxazole (TMP-SMX) S. pneumoniae resistance. In addition to individual agent resistance, there is a high degree of antibiotic cross-resistance to penicillin, macrolides and TMP-SMX resistant strains of S. pneumoniae. Strains of S. pneumoniae resistant to three or more antimicrobial classes are termed multi-drug resistant S. pneumoniae (MDRSP). Respiratory quinolones such as levofloxacin, gatifloxacin, moxifloxacin, or gemifloxacin are excellent antimicrobials for MDRSP. Levofloxacin, in particular, has been used to treat therapeutic failures of CAP due to S. pneumoniae initially treated with -lactams, ciprofloxacin, or macrolides. There has not been an increase in pneumococcal resistance to respiratory quinolones. The role of the respiratory quinolones, especially levofloxacin, is in preventing/treating CAP due to MDRSP.

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