Letters to the Editor
Medication Options for the Treatment of CAP
Am Fam Physician. 2006 Nov 1;74(9):1479.
to the editor: We would like to compliment the authors of “Diagnosis and Treatment of Community-Acquired Pneumonia,”1 on their excellent overview of this condition. However, we wish to point out that three medications we feel deserve mention were not included in their article.
Gemifloxacin (Factive) is a newly released oral fluoroquinolone that is the most potent in vitro of the respiratory fluoroquinolones against Streptococcus pneumoniae, including multi-drug resistant strains. It has been approved by the U.S. Food and Drug administration (FDA), has performed very well in clinical trials,2,3 and is safe.4
Telithromycin (Ketek) is the first ketolide to be approved by the FDA and is a derivative of the macrolide class. It also is effective against multi-drug resistant S. pneumoniae including strains resistant to macrolides such as erythromycin, azithromycin (Zithromax), and clarithromycin (Biaxin), and as such, is an appropriate option when macrolide resistance is a concern (e.g., with recent use of macrolides or other antimicrobials, or the presence of medical comorbidities).5
The third agent not included in the review is high-dose amoxicillin (defined as either amoxicillin 1 g three times daily, or amoxicillin/clavulanate [Augmentin] extended-release 2 g twice daily), which is an alternative to a respiratory fluoroquinolone in the at-risk outpatient when prescribed with a macrolide.6
Finally, we note that discussion of community-acquired pneumonia (CAP) caused by Pseudomonas aeruginosa is not mentioned. Although this type of infection is not common, it is associated with significant morbidity and mortality, and P. aeruginosa appears to be the most common enteric gram-negative bacterial cause of CAP, especially among patients with chronic obstructive pulmonary disease.6
1. Lutfiyya MN, Henly E, Chang LF, Reyburn SW. Diagnosis and treatment of community-acquired pneumonia. Am Fam Physician. 2006;73:442–50.
2. File TM Jr, Schlemmer B, Garau J, Cupo M, Young C, for the 049 Clinical Study Group. Efficacy and safety of gemifloxacin in the treatment of community-acquired pneumonia: a randomized, double-blind comparison with trovafloxacin. J Antimicrob Chemother. 2001;48:67–74.
3. Lode H, File TM Jr, Mandell L, Ball P, Pypstra R, Thomas M, 185 Gemifloxacin Study Group. Oral gemifloxacin versus sequential therapy with intravenous ceftriaxone/oral cefuroxime with or without a macrolide in the treatment of patients hospitalized with community-acquired pneumonia: a randomized, open-label, multicenter study of clinical efficacy and tolerability. Clin Ther. 2002;24:1915–36.
4. Ball P, Mandell L, Patou G, Dankner W, Tillotson G. A new respiratory fluoroquinolone, oral gemifloxacin: a safety profile in context. Int J Antimicrob Agents. 2004;23:421–9.
5. Tellier G, Niederman MS, Nusrat R, Patel M, Lavin B. Clinical and bacteriological efficacy and safety of 5 and 7 day regimens of telithromycin once daily compared with a 10 day regimen of clarithromycin twice daily in patients with mild to moderate community-acquired pneumonia. J Antimicrob Chemother. 2004;54:515–23.
6. Mandell LA, Bartlett JG, Dowell SF, File TM Jr, Musher DM, Whitney C, for the Infectious Diseases Society of America. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis. 2004:37:1405–33.
editor’s note: This letter was sent to the authors of “Diagnosis and Treatment of Community-Acquired Pneumonia,” who declined to reply.
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