Infection
Update

Respiratory tract infections (RTI) continue to pose serious problems for patients and health care systems around the world. It is fortunate that the respiratory fluoroquinolones, lead by levofloxacin, continue to provide an effective and well-tolerated option for treating these common problems. Levofloxacin has been shown to be successful in managing pneumonia, sinusitis and other RTI, with research also high-lighting its role in acute bacterial exacerbations of chronic obstructive pulmonary disease (ABECOPD). While treatment of these exacerbations requires a multidimensional approach incorporating both medical and non-medical self-help measures, ultimately, many patients require antimicrobial therapy. These patients respond to levofloxacin therapy and recent research has shown that its role is likely to increase, particularly in Asia, where microbiologic data has indicated a change in likely pathogens in certain areas. Until now, there has been general agreement that the three major bacterial pathogens responsible for ABECOPD are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, and that to be effective, selected antimicrobials must be active against these pathogens. However, it has recently been shown that the etiology of ABECOPD in Asia can vary dramatically according to geographical region. In particular, a rise in infections caused by Pseudomonas aeruginosa and the Gram-negatives Klebsiella pneumoniae and Acinetobacter baumannii has been found in specific areas. Unlike most other antimicrobials, levofloxacin has maintained its efficacy against all these pathogens making it an extremely useful option for treating ABECOPD and other RTI throughout the region. To discuss this research and the implications for management of RTI, Penetration interviewed Hans H. Liu, Infectious Diseases Consultant, Bryn Mawr Medical Specialists, Pennsylvania, United States of America. Professor Liu summarized the role of levofloxacin in treating RTI, using results from a recent Asia-Pacific Advisory Board (APAB)* study that evaluated the bacterial etiology of ABECOPD throughout Asia.

*A prospective observational study of the prevalence of pathogens and their antimicrobial susceptibilities in patients with ABECOPD was conducted in Indonesia, the Philippines, Korea, Thailand, Malaysia, Taiwan, Hong Kong and China from August 2006 to April 2008. The MICs of 16 antibiotics, including levofloxacin, were determined according to CLSI. A total 775 isolates were identified among 1,331 cases of AECOPD. APAB principle investigators are as follows: Dr. Hadiarto Mangunnegoro, Indonesia; Dr. Baiyi Chen, China; Dr. David Shu Cheong Hui, Hong Kong; Dr. Priyanti Zuswayudha, Indonesia; Dr. Chul-Gyu Yoo, Korea; Dr. Abdul Razak Muttalif, Malaysia; Dr. Camilo Roa, the Philippines; Dr. Shan-Chwen Chang, Taiwan; Dr. Visit Udompanich, Thailand; Dr. Hans H. Liu, MD, FACP, USA.

Question

Q01 How has the introduction and continued availability of fluoroquinolones affected infectious diseases, particularly respiratory tract infections (RTI)?
Q02 You mention the benefit of an oral, once-daily dosing schedule. Could you comment on the pharmacologic features of fluoroquinolones that make this possible?
Q03 Are these advantageous pharmacologic features present in patients with acute bacterial exacerbations of chronic obstructive pulmonary disease (ABECOPD)?
Q04 There now seems to be mounting evidence supporting a shorter duration of therapy, with levofloxacin in particular being promoted as a high-dose, short-course regimen. Could you comment on the rationale behind the development of this schedule?
Q05 Are there any cost advantages associated with this regimen?
Q06 The development of fluoroquinolones has seen many withdrawn from the market, while levofloxacin has continued to be both effective and well tolerated. Could you discuss the progression of fluoroquinolone development?
Q07 Could you compare levofloxacin with other respiratory tract antimicrobials?
Q08 What dose and duration of levofloxacin therapy do you recommend?
Q09 You mentioned that the 750 mg dose has a similar tolerability to the 500 mg dose. Could you comment further on this?
Q10 Do clinical trial data support the safety of the 750 mg dose?
Q11 You mention possible differences based on body mass, does this have an effect when treating Asian people, who tend to be smaller?
Q12 Are there any problems in treating RTI that are specific to Asia?
Q13 ABECOPD is a common problem, but there still seems to be debate about its appropriate management. What do you think?
Q14 What are the most likely bacterial pathogens responsible for ABECOPD?
Q15 Are the pathogens responsible for ABECOPD the same in different geographic regions?
Q16 Could you describe the results in more detail?
Q17 What regional differences were noted?
Q18 What were the major regional trends in antibacterial susceptibility reported in the Asia Pacific study?
Q19 What are the regional differences in activity profiles between individual fluoroquinolones?
Q20 What were the main differences between individual fluoroquinolones in terms of activity against the most common respiratory pathogens?
Q21 Were any differences identified in regard to bacterial susceptibility to levofloxacin compared with non-fluoroquinolone agents?
Q22 What are possible reasons for the regional differences in prevalence of ABECOPD pathogens?
Q23 What are the implications of this data for treatment practice?
Q24 Do you think levofloxacin is a better choice than moxifloxacin when treating ABECOPD in countries with higher prevalence rates of P. aeruginosa infection?
Q25 Could you discuss the role of guidelines in managing AECOPD?
Q26 What other factors need to be considered when choosing antibacterial treatment of ABECOPD in Asia?
Q27 Resistance is a growing global concern and one that requires judicious use of available antibiotics. How does this problem result in changes to prescribing?
Q28 What is the public health impact of COPD, particularly in Asia?
Q29 What are the most important areas of future research in ABECOPD?

References

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