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
THOMAS M. FILE, JR., M.D.
Summa Health System
Northeastern Ohio Universities College of Medicine
75 Arch St., Suite 105
Akron, OH 44304
PAUL B. IANNINI, M.D.
24 Hospital Ave.
Danbury, CT 06081
REFERENCESshow all references
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.
Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: email@example.com, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.
Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 2006 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions