Respiratory Fluoroquinolones: Differences in the Details

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Issue Cover
Volume 38
Issue 9

1 May 2004

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Respiratory Fluoroquinolones: Differences in the Details

L. A. Mandell

1McMaster University, Hamilton, Ontario, Canada

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    L. A. Mandell, P. B. Iannini, G. S. Tillotson; Respiratory Fluoroquinolones: Differences in the Details, Clinical Infectious Diseases, Volume 38, Issue 9, 1 May 2004, Pages 1331–1332, https://doi.org/10.1086/383153

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Sir—We would like to both comment on and expand on some of the points raised by Saravolatz and Leggett [ 1 ] in their review of the newer fluoroquinolones in the 1 November issue. They noted the increased in vitro potency of these agents against Streptococcus pneumoniae; however, the major difference between drugs of this class is their intrinsic activity. Moreover, as recognized by the US Food and Drug Administration (FDA) in their approval statement for gemifloxacin in April 2003, gemifloxacin is the only agent that displays activity against both fluoroquinolone target sites at therapeutically achievable levels. Several studies have confirmed this activity against strains of S. pneumoniae that possess genes with fluoroquinolone-resistance mutations of gyrA, parC, or both [ 2 , 3 ]. This property may be important, because, as the authors rightly note, there is a threat of increasing fluoroquinolone resistance even among community isolates of S. pneumoniae [ 4 , 5 ]. Thus, in order to consistently provide the optimal conditions to eradicate or prevent the selection of resistant first-step mutants, it is necessary to use an agent that combines the best pharmacodynamic properties with the lowest MICs against these strains at each of the 2 targets.

In comparing pharmacodynamic parameters, it is important to use data from isolates from the same study and not to merge data from different sources. The FDA package insert data are a consistent benchmark and yield somewhat different pharmacodynamic parameters for S. pneumoniae than those reported by Saravolatz and Leggett ( table 1 ) [ 6–8 ].

Table 1
Pharmacodynamic parameters of gemifloxacin in comparison with other fluoroquinolones against Streptococcus pneumoniae.

View large Download slide

Pharmacodynamic parameters of gemifloxacin in comparison with other fluoroquinolones against Streptococcus pneumoniae.

Table 1
Pharmacodynamic parameters of gemifloxacin in comparison with other fluoroquinolones against Streptococcus pneumoniae.

View large Download slide

Pharmacodynamic parameters of gemifloxacin in comparison with other fluoroquinolones against Streptococcus pneumoniae.

Comparison of clinical responses to the 3 new fluoroquinolones (i.e., gatifloxacin, gemifloxacin, and moxifloxacin) shows some differentiating features between the drugs. Regulatory-agency studies are designed to show noninferiority in comparative clinical trials. All of the regulatory-agency studies that have compared gatifloxacin and moxifloxacin with other fluoroquinolones achieved this goal. In contrast, File et al. [ 9 ] reported a comparison of gemifloxacin with trovafloxacin for treatment of community-acquired pneumonia (CAP) in which gemifloxacin was shown to be superior in the intention-to-treat (ITT) population for clinical outcomes. Another stufy showed that gemifloxacin was superior to trovafloxacin in the ITT population of a cohort of patients with acute exacerbations of chronic bronchitis (AECB) [ 10 ]. An additional clinical trial that compared gemifloxacin with levofloxacin for the treatment of AECB showed a statistically significant difference in favor of gemifloxacin in long-term clinical success at 6 weeks after the end of therapy. Comparisons of gatifloxacin with levofloxacin for treatment of CAP and comparisons of gatifloxacin with moxifloxacin for treatment CAP or AECB due to the same agent showed only noninferiority [ 11–14 ]. Unfortunately, no findings of comparative trials involving gemifloxacin, moxifloxacin, or gatifloxacin have been published.

Finally, we agree with Saravolatz and Leggett [ 1 ] that the 3 new fluoroquinolones appear to be safe and as well-tolerated as other antibiotics used in the community. However, we wish to point out that gemifloxacin is associated with a higher rate of rash in females aged <40 years. The rate of rash increases to 1%–2% of patients with 7 days of therapy to >12% with >8 days of therapy. Gemifloxacin is approved only for lengths of therapy of ⩽7 days. The overall rate of drug-related rash is 2.8%. The rash is mild-to-moderate in severity, has little to no impact on daily activities, and disappears on cessation of therapy. More-serious dermatologic reactions, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, or eosinophilic dermatosis, have not been reported. A study involving 1044 volunteers showed that most rashes were similar to those seen in treatment with ampicillin [ 3 ].

We wish to conclude by strongly endorsing Saravolatz and Leggett’s closing comment, which advocates use of the most appropriate fluoroquinolone in specific infections on the basis of the pathogen most likely to be the cause of the infection, and by supporting Scheld’s [ 15 ] approach, that the drug with the best pharmacodynamics should be used to treat infection caused by the probable organisms.

references

1
Saravolatz
LD

Leggett
J

Gatifloxacin, gemifloxacin, and moxifloxacin: the role of 3 newer fluoroquinolones

Clin Infect Dis

 , 

2003

, vol. 

37

 (pg. 

1210

5

)

Google Scholar
Crossref
Search ADS
PubMed

 

2
Heaton
VJ

Ambler
JE

Fisher
LM

Potent antipneumococcal activity of gemifloxacin is associated with dual targeting of gyrase and topoisomerase IV, an in vivo target preference for gyrase, and enhanced stabilization of cleavable complexes in vitro

Antimicrob Agents Chemother

 , 

2000

, vol. 

44

 (pg. 

3112

7

)

Google Scholar
Crossref
Search ADS
PubMed

 

3
Gemifloxacin (Factive), Package Insert, 2003, Genesoft Pharmaceuticals, San Francisco, CA

 

4
Lim
S

Bast
D

McGeer
A

de Azavedo
J

Low
DE

Antimicrobial susceptibility breakpoints and first-step parC mutations in Streptococcus pneumoniae: redefining fluoroquinolone resistance

Emerg Infect Dis

 , 

2003

, vol. 

9

 (pg. 

833

7

)

Google Scholar
Crossref
Search ADS
PubMed

 

5
Jones
RN

Biedenbach
DJ

Beach
ML

Influence of patient age on the susceptibility patterns of Streptococcus pneumoniae isolates in North America (2000–2001): report from the SENTRY Antimicrobial Surveillance Program

Diagn Microbiol Infect Dis

 , 

2003

, vol. 

46

 (pg. 

77

80

)

Google Scholar
Crossref
Search ADS
PubMed

 

6
Gatifloxacin (Tequin), package insert, Bristol-Myers-Squibb Pharmaceuticals, Princeton, NJ

 , 

2003
7
Moxifloxacin (Avelox), package insert, Bayer Pharmaceuticals, West Haven, CT

 , 

2003
8
Levofloxacin (Levaquin), package insert , Ortho-McNeil Pharmaceuticals, Raritan, NJ

 , 

2002
9
File
TM

Jr

Schlemmer
B

Garau
J

Cupo
M

Young C, 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

, vol. 

48

 (pg. 

67

74

)

Google Scholar
Crossref
Search ADS
PubMed

 

10
Ball
P

Wilson
R

Mandell
L

Brown
J

Henkel T, the 069 study group. Efficacy of gemifloxacin in acute exacerbations of chronic bronchitis: a randomized, double-blind comparison with trovafloxacin

J Chemother

 , 

2001

, vol. 

13

 (pg. 

288

98

)

Google Scholar
Crossref
Search ADS
PubMed

 

11
Sullivan
JG

McElroy
AD

Honsinger
RW

, et al. 

Treating community-acquired pneumonia with once-daily gatifloxacin versus once-daily levofloxacin

Journal of Respiratory Diseases

 , 

1999

, vol. 

20

 

(Suppl)

(pg. 

49

59

)

12
Hautamaki
D

Bruya
T

Kureishi
A

Warner
J

Church
D

Short course 5-day moxifloxacin versus 7-day levofloxacin therapy in the treatment of acute exacerbations of chronic bronchitis (AECB)

Today’s Therapeutic Trends

 , 

2001

, vol. 

19

 (pg. 

117

36

)

13
Ureta
J

Ariza
H

DeBrito
JR

, et al. 

Safety and efficacy of moxifloxacin versus levofloxacin in the treatment of AECB

European Congress of Clinical Microbiology and Infectious Diseases, Istanbul, Turkey, 2001, abstract P864

 

14
File
TM

Jr

Larsen
LS

Fogarty
CM

, et al. 

Safety and efficacy of sequential (IV to PO) moxifloxacin for the treatment of community-acquired pneumonia in hospitalized patients

Today’s Therapeutic Trends

 , 

2002

, vol. 

19

 (pg. 

251

70

)

15
Scheld
WM

Maintaining fluoroquinolone class efficacy: review of influencing factors

Emerg Infect Dis

 , 

2003

, vol. 

9

 (pg. 

1

9

)

Google Scholar
Crossref
Search ADS
PubMed

 

16
Andrews
JM

Honeybourne
D

Jevons
G

Brenwald
NP

Cunningham
B

Wise
R

Concentrations of levofloxacin (HR355) in the respiratory tract following a single oral dose in patients undergoing fibre-optic bronchoscopy

J Antimicrob Chemother

 , 

1997

, vol. 

40

 (pg. 

573

7

)

Google Scholar
Crossref
Search ADS
PubMed

 

17
Honeybourne
D

Banerjee
D

Andrews
J

Wise
R

Concentrations of gatifloxacin in plasma and pulmonary compartments following a single 400 mg oral dose in patients undergoing fibre-optic bronchoscopy

J Antimicrob Chemother

 , 

2001

, vol. 

48

 (pg. 

63

6

)

Google Scholar
Crossref
Search ADS
PubMed

 

18
Soman
A

Honeybourne
D

Andrews
J

Jevons
G

Wise
R

Concentrations of moxifloxacin in serum and pulmonary compartments following a single 400 mg oral dose in patients undergoing fibre-optic bronchoscopy

J Antimicrob Chemother

 , 

1999

, vol. 

44

 (pg. 

835

8

)

Google Scholar
Crossref
Search ADS
PubMed

 

© 2004 by the Infectious Diseases Society of America

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