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.
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