Antimicrobial Treatment Of Lower Respiratory Tract Infections In The Hospital Setting


Antimicrobial Treatment Of Lower Respiratory Tract Infections In The Hospital Setting


Grossman R F; Rotschafer J C; Tan J S


American Journal of Medicine




Respiratory tract infections (RTIs) that may require hospitalization include acute exacerbations of chronic bronchitis (AECB), community-acquired pneumonia (CAP), and hospital-acquired pneumonia (HAP), which includes ventilator-associated pneumonia (VAP). Healthcare-associated pneumonia (HCAP) is treated similar to HAP and may be considered with HAP. For CAP requiring hospitalization, the current guidelines for the treatments of RTIs generally recommend either a beta-lactam and macrolide combination or a fluoroquinolone. The respiratory fluoroquinolones (levofloxacin, gatifloxacin, moxifloxacin, and gemifloxacin) are excellent antibiotics due to high levels of susceptibility among gram-negative, gram-positive, and atypical pathogens. The fluoroquinolones are active against >98% of Streptococcus pneumoniae, including penicillin-resistant strains. Fluoroquinolones are also recommended for AECB requiring hospitalization. Evidence from clinical trials suggests that levofloxacin monotherapy is as efficacious as combination ceftriaxone-erythromycin therapy in the treatment of patients hospitalized with CAP. For early-onset HAP, VAP, and HCAP without the risk of multidrug resistance, ceftriaxone, ampicillin-sulbactam, ertapenem, or one of the fluoroquinolones is recommended. High-dose, short-course therapy regimens may offer improved treatment due to higher drug concentrations, more rapid killing, increased adherence, and the potential to reduce development of resistance. Recent studies have shown that short-course therapy with levofloxacin, azithromycin, or telithromycin in patients with CAP was effective, safe, and tolerable and may control the rate of resistance. (C) 2005 Elsevier Inc. All rights reserved.


5-day levofloxacin; acute exacerbations; antibiotic-therapy; antibiotics; chronic-bronchitis; community-acquired pneumonia; community-associated pneumonia; drug-interaction; General & Internal Medicine; healthcare-associated; hospital-acquired; open-label; quinolones; randomized-trial; streptococcus-pneumoniae; ventilator-associated; ventilator-associated pneumonia


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Grossman R F; Rotschafer J C; Tan J S, “Antimicrobial Treatment Of Lower Respiratory Tract Infections In The Hospital Setting,” NEOMED Bibliography Database, accessed September 21, 2023,