Question 19

What future research do you think is needed in this area?

We need to continuously monitor patients, using retrospective data following empirical treatment. We also need to more fully investigate the bactericidal activity of fluoroquinolones against resistant isolates. Microbiological data including MIC and resistance rates can be correlated with bactericidal killing curves and ultimately patient outcome. It is imperative that surveillance studies are continued, to enable physicians to base their treatment on local regional resistance patterns. Moreover, we should investigate, in the light of pneumococal vaccination, the impact on resistance, including not only beta-lactams and macrolides but also fluoroquinolones. Clonal replacement, if it is the case, and/or the impact on antimicrobial resistance deserves our attention.

We know that levofloxacin is a very safe drug, even when used at high doses. However, this is not true for all fluoroquinolones and we need to confirm the safety of other agents. This is especially important when assessing the safety of high dose regimens, which are recommended for patients with serious infections or those caused by P. aeruginosa , in order to avoid the development of resistance and to obtain better clinical outcomes.