JAC Advance Access originally published online on August 6, 2007
Journal of Antimicrobial Chemotherapy 2007 60(4):902-903; doi:10.1093/jac/dkm290
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Correspondence |
Comment on: Gemifloxacin once daily for 5 days versus 7 days for the treatment of community-acquired pneumonia: a randomized, multicentre, double-blind study
Department of Pediatrics, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203-2098, USA
* Tel: +1-718-270-3097; Fax: +1-718-270-1985; E-mail: mhammerschlag{at}downstate.edu
Keywords: microbiological efficacy , Chlamydia pneumoniae , Mycoplasma pneumoniae
Assessing the microbiological efficacy of antibiotic treatment against respiratory infections caused by atypical organisms, specifically Chlamydia pneumoniae and Mycoplasma pneumoniae, is difficult. Culturing is difficult and not readily available. There are no validated, commercially available nucleic acid amplification tests for either organism.1 Recently, File et al.2 reported a study comparing 5 day versus 7 day treatment of community-acquired pneumonia with gemifloxacin. They used serology alone to determine whether patients were infected with C. pneumoniae and M. pneumoniae. The authors state in the Methods section that ‘because only serology was used for identification, bacteriological outcome was presumed on the basis of clinical response’. However, under ‘bacteriologic outcomes’, they state that C. pneumoniae and M. pneumoniae were ‘identified’ and refer to ‘eradication’ of these organisms in Table 3. Unfortunately, serology, especially for C. pneumoniae, is not standardized and correlates poorly with identification of the organism by culture or validated PCR.1 As many as 40% to 70% of patients with culture-documented C. pneumoniae infection will remain seronegative.1 Serology does not detect or identify an organism; it indicates possible exposure. We have previously demonstrated in two studies of community-acquired pneumonia in adults, utilizing cultures, that treatment with levofloxacin or moxifloxacin eradicated C. pneumoniae from 80% and 70% of infected patients, respectively.3,4 We also demonstrated poor correlation between serology, using the microimmunofluorescence assay, and culture. However, the patients who were microbiological failures were clinical cures, despite persistence of the organism. In vitro activity does predict in vivo efficacy. The MICs of moxifloxacin and gemifloxacin for C. pneumoniae are very similar.5
Use of serology, at best, only allows a clinical endpoint. We need a consistent policy on acceptable criteria for determining microbiological efficacy for C. pneumoniae and M. pneumoniae infection.
None to declare.
References
1 Kumar S, Hammerschlag MR. Acute respiratory infection due to Chlamydia pneumoniae: current status of diagnostic methods. Clin Infect Dis (2007) 44:568–76.[CrossRef][Web of Science][Medline]
2
File TM Jr, Mandell LA, Tillotson G, et al. Gemifloxacin once daily for 5 days versus 7 days for the treatment of community-acquired pneumonia: a randomized, multicentre, double-blind study. J Antimicrob Chemother (2007) 60:112–20.
3
Hammerschlag MR, Roblin PM. Microbiologic efficacy of levofloxacin for the treatment of community-acquired pneumonia due to Chlamydia pneumoniae. Antimicrob Agents Chemother (2000) 44:1409.
4 Hammerschlag MR, Roblin PM. Microbiologic efficacy of moxifloxacin for the treatment of community-acquired pneumonia due to Chlamydia pneumoniae. Int J Antimicrob Agents (2000) 15:149–52.[CrossRef][Web of Science][Medline]
5 Hammerschlag MR. Activity of gemifloxacin and other new quinolones against Chlamydia pneumoniae: a review. J Antimicrob Chemother (2000) 45(Suppl_1):35–9.[Abstract]
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