All GISA strains were susceptible to TMP-SMX. In addition, it appears that TMP-SMX may have concentration-dependent antibacterial activity against these organisms. As an option in the management of GISA infection, TMP-SMX merits further study.
Hospitalized cases of community-acquired pneumonia (CAP) were reviewed to determine the outcome of changing the empiric first-line therapy for CAP from ceftriaxone ± azithromycin to gatifloxacin. A 27-month period was evaluated. Seven hundred ninety-six cases were identified; 326 preempiric (period 1) and 470 postempiric antibiotic change (period 2). In period 2, 264 patients received gatifloxacin as a component of their antibiotic therapy and 123 received gatifloxacin as the sole antibiotic. Length of stay (LOS) was 4.87 days for patients receiving gatifloxacin-containing regimens and 3.82 days for those treated with gatifloxacin-monotherapy, compared with 5.54 days for non-gatifloxacin-treated cases ( p < 0.0001). These reductions in LOS equate to a cost savings of $120,278 to $143,860 for the institution. Total hospital charges, pharmacy charges and antibiotic costs were also significantly reduced in period 2. The first dose of gatifloxacin was administered 1.54 hours earlier than nongatifloxacin regimens ( p = 0.001). Newer fluoroquinolones offer significant cost reductions and LOS advantages over nonfluoroquinolone regimens in the treatment of CAP. (Infect Dis Clin Pract 2002;11:540-549)
Several new fluoroquinolones have been marketed since the late 1990s. Fluoroquinolones are an effective treatment for most community-acquired respiratory tract infections, including acute sinusitis, acute exacerbations of chronic bronchitis and community-acquired pneumonia. However, other antibiotics, including beta-lactams, macrolides, tetracyclines and trimethoprim-sulfamethoxazole, are also effective against these respiratory infections. From a managed care perspective, it is the subtle differences between the drugs in the eradication of bacterial pathogens, adverse effects, dose regimens, compliance issues, bacterial resistance and cost that determine the best choice for the management of pneumonia, sinusitis or exacerbations of chronic bronchitis. The potential for bacterial resistance is perhaps the only significant barrier to extensive fluoroquinolone use in community-acquired respiratory tract infections. Cost-effectiveness must be balanced with quality care, both from an individual perspective and that of the greater society.
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