Its use in evaluating antimicrobial treatment of acute exacerbations of chronic bronchitis.
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Die Gesetzliche Öffnungen zur Vereinbarung von Mitbestimmung in. Zudem unterliegen die AVB der. Schwerpunkt der Berichterstattung bilden die mit den spezifischen Gegebenheiten des. Verträge auf der Basis von Leistung und Gegenleistung abgeschlossen werden können hingegen nicht mit den. However, many fluoroquinolones have shown efficacy and tolerability when used to treat large numbers of patients worldwide. Adverse drug reactions ADRs common to all types of fluoroquinolone therapy can be summarized as class effects, subdivided into common and rare class reactions and potentially serious idiosyncratic reactions, as follows.
These effects occur at varying rates relevant to individual agents but are rarely serious. Rare-class ADRs include phototoxicity, QTc heart rate—corrected QT prolongation and associated cardiac arrhythmias, tendonitis, and, rarely, target organ damage. For common-class ADRs, rates for levofloxacin appear to be among the lowest of the class, irrespective of racial, geographic, or chronologic factors.
Phototoxicity is a potential risk with all contemporary fluoroquinolones, 55 notably those with multiple fluorine side-chain substitution fleroxacin, sparfloxacin and those with a chlorine substituent at the 8-position clinafloxacin, Bay y Prolongation of the QTc by fluoroquinolones and their potential for precipitation of ventricular arrhythmia is a concern.
IKr , is a class effect. Torsades de pointes and other ventricular arrhythmias have been reported with all contemporary fluoroquinolones. Such fluoroquinolone therapy—associated cases have occurred almost invariably in highly predisposed patients. If coexistent and often multiple risk factors are considered, few reports can be considered unequivocally causally related to fluoroquinolone use. Thus, there has been some overreaction to what appears to be a rare event.
Fluoroquinolones have a minimal risk for provoking torsades de pointes in most patients and should be considered tolerable for routine patient management. Quinolone-related tendonitis and tendon rupture, caused by collagen damage and possibly relating to hypomagnesemia, 79 are rare events.
They may be bilateral and often affect the Achilles tendon. Treatment, except for withdrawal of fluoroquinolone therapy and rest, usually is not required except in some cases of Achilles tendon rupture, which may require surgical intervention.
Registration authorities in France have drawn attention to the higher risk for tendonitis in elderly patients receiving fluoroquinolones and concomitant steroid therapy. Spontaneous reports of drug toxicity in the postmarketing phase are often incomplete; occur against a poorly defined, chronologically asynchronous denominator population; and involve considerable observer error 57,78 in relation to the compound, severity of response, requirement for corrective or therapeutic action, and contribution of comorbidity and concomitant therapy.
Nonetheless, interesting comparisons can be made in terms of the rate of spontaneous reports during the immediate postlaunch period 4 and 15 months after launch. More than million patients have now been treated with levofloxacin, and the pattern of PMS reports remains similar to those observed with the other fluoroquinolones.
Levofloxacin has established itself as one of the leading fluoroquinolone agents during the past 5 years. It has shown clinical efficacy in CAP similar to that of gatifloxacin, and is at least as efficacious as the third-generation cephalosporins. Extensive clinical data confirm the good tolerability profile of levofloxacin without the phototoxicity or hepatic and cardiac AEs found with some other newer fluoroquinolone drugs.
Therefore, levofloxacin offers a combination of documented efficacy and tolerability, and has an established place in the routine treatment of bacterial infections, including CAP and AECB. Reproduction in whole or part is not permitted. National Center for Biotechnology Information , U. Curr Ther Res Clin Exp. Lately University of St. Andrews, Fife, Scotland, United Kingdom. Accepted Sep Published by Elsevier Inc.
This article has been cited by other articles in PMC. Objective This review examines the efficacy and safety of fluoroquinolones and the specific clinical evidence regarding levofloxacin.
Methods Using published literature collected over time by the author, a review was conducted, focusing on the efficacy and safety profile of levofloxacin and other fluoroquinolones. Results The newer fluoroquinolones have fulfilled many of the research goals described above. Conclusions Levofloxacin offers a combination of documented efficacy and tolerability, and provides an important option for the treatment of bacterial infections, including CAP and AECB, compared with standard agents used in the management of lower respiratory tract infections.
Introduction Over the past decade, the development of successive generations of fluoroquinolones, such as levofloxacin, grepafloxacin, sitafloxacin, sparfloxacin, trovafloxacin, moxifloxacin, gatifloxacin, and gemifloxacin, 1 has been prompted primarily by the lesser in vitro potency of the original second-generation agents, such as ciprofloxacin, against Streptococcus pneumoniae.
Materials and methods Using published literature collected over time by the author, a review was conducted, focusing on the efficacy and safety profile of levofloxacin and other fluoroquinolones. Microbiologic considerations The modern fluoroquinolones have comprehensive activity against the major respiratory pathogens. Fluoroquinolone efficacy in community-acquired pneumonia The newer fluoroquinolones have been widely assessed in a number of recent clinical trials 4,5 in CAP of varying severity.
The case for cost-effectiveness Fluoroquinolones are expensive drugs; therefore, their use must be justified by improved outcomes that indicate overall cost-effectiveness. Adverse effects Fluoroquinolone development over the past 15 years has not been without problems. QT Interval Prolongation and Ventricular Arrhythmia Prolongation of the QTc by fluoroquinolones and their potential for precipitation of ventricular arrhythmia is a concern.
Tendonitis and Tendon Rupture Quinolone-related tendonitis and tendon rupture, caused by collagen damage and possibly relating to hypomagnesemia, 79 are rare events. Postmarketing surveillance Spontaneous reports of drug toxicity in the postmarketing phase are often incomplete; occur against a poorly defined, chronologically asynchronous denominator population; and involve considerable observer error 57,78 in relation to the compound, severity of response, requirement for corrective or therapeutic action, and contribution of comorbidity and concomitant therapy.
Conclusions Levofloxacin has established itself as one of the leading fluoroquinolone agents during the past 5 years. Academic Press; San Diego, Calif: Therapeutic advances of new fluoroquinolones. Exp Opin Invest Drugs. Quinolone-induced QT interval prolongation: A not-so-unexpected class effect. Treatment of community-acquired respiratory tract infections. Future of the quinolones.
Strategies for optimal outcomes and minimized resistance emergence. Treatment of drug-resistant pneumococcal pneumonia. Failure of macrolide antibiotic treatment in patients with bacteraemia due to erythromycin-resistant Streptococcus pneumoniae.
Diagnosis, assessment of severity, antimicrobial therapy, and prevention. British Thoracic Society Guidelines for the management of community-acquired pneumonia in adults. Japanese guidelines for the management of community-acquired pneumonia.
Int J Antimicrob Agents. The role of fluoroquinolones in respiratory tract infections. The role of fluoroquinolones in chronic obstructive pulmonary disease. Curr Opin Infect Dis. Causes, epidemiology and treatment of bronchial infections. Increasing resistance of Streptococcus pneumoniae to fluoroquinolones: Results of a Hong Kong multicentre study in Phenotypic and genotypic analysis of levofloxacin-resistant clinical isolates of Streptococcus pneumoniae collected in 13 countries during — N Engl J Med.
A nosocomial outbreak of fluoroquinolone-resistant Streptococcus pneumoniae. Risk factors for acquisition of levofloxacin-resistant Streptococcus pneumoniae: A case control study.