Letters to the Editor
Medication Options for the Treatment of CAP
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
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 Kenny Lin, M.D., Contributing Editor, American Family Physician, e-mail: afplet@aafp.org. Letters submitted via regular mail should be sent to: 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-6272.
Please include your complete address, telephone number, fax number, and e-mail address. Letters should be fewer than 500 words, and limited to one table or figure and six references (including citation of original article). Please submit a word count.
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. Letters will be edited to meet style and space requirements.
| Copyright © 2006 by the American
Academy of Family Physicians. |
