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Fluoroquinolones for the Treatment of Other Respiratory Tract Infections: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Last updated: May 31, 2019
Project Number: RC1123-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of fluoroquinolones for the treatment of ‘other’ respiratory tract infections?
  2. What is the cost-effectiveness of fluoroquinolones for the treatment of ‘other’ respiratory tract infections?
  3. What are the evidence-based guidelines for the use of fluoroquinolones for the treatment of ‘other’ respiratory tract infections?

Key Message

Overall, six publications met the eligibility criteria and were included in this report. Two of the included publications were systematic reviews; one systematic review which examined antibiotic use (including fluoroquinolones) in patients with acute rhinosinusitis, and one systematic review with a meta-analysis and a network meta-analysis which examined anti-bacterial agents (including fluoroquinolones) for patients with bronchitis. In the treatment of bronchitis, no significant differences in treatment efficacy for total pathogen eradication were noted in the meta-analysis or network meta-analysis, however, based on the surface under the cumulative ranking curve, the authors reported that gemifloxacin and levofloxacin were found to be high ranking in total pathogen eradication efficacy. In the systematic review of the treatment of acute rhinosinusitis, levofloxacin was found to be the most effective treatment. One non-randomized study was included, which retrospectively analyzed patients with lower respiratory tract infections who had been treated with ceftriaxone sodium, ceftizoxime sodium, levofloxacin or azithromycin. The authors reported no statistically significant differences in the effectiveness rates of the antibiotics compared, but found levofloxacin had the lowest treatment costs. No evidence related to the cost-effectiveness of fluoroquinolones for the treatment of lower respiratory tract infections was identified. Three guidelines were identified; one informing the treatment of acute exacerbations of bronchiectasis (non-cystic fibrosis) from the National Institute for Health Care and Excellence, one informing the treatment of bronchiectasis in adults from the British Thoracic Society, and one informing the treatment of chronic suppurative lung disease and bronchiectasis from the Thoracic Society of Australia and New Zealand. The British Thoracic Society and the Thoracic Society of Australia and New Zealand guidelines recommends ciprofloxacin as a first line treatment for patients with Pseudomonas aeruginosa. The National Institute for Health Care and Excellent recommends levofloxacin for adults and ciprofloxacin (on specialist advice) for children as second line oral treatments for patients at high risk of treatment failure or as first line intravenous treatment. While the three guidelines provided similar recommendations for the use of fluoroquinolones in the treatment of bronchiectasis (non-cystic fibrosis), the variable findings and methodological limitations in the body of evidence identified for other conditions, including bronchitis and acute rhinosinusitis, to inform this report limit generalizability and warrant caution in its interpretation for the clinical effectiveness and cost-effectiveness of fluoroquinolones for the treatment of respiratory tract infections.