Fluoroquinolones for the Treatment of Respiratory Tract Infections: A Review of Clinical Effectiveness,

Key Message

Overall, 15 publications met the eligibility criteria and were included in this report. Ten of the included publications were systematic reviews/meta-analyses; nine of which examined fluoroquinolone use in patients with pneumonia, while one included systematic review/meta-analysis examined fluoroquinolone use in patients with chronic obstructive pulmonary disease. The systematic reviews examining pneumonia were of variable quality and reported inconsistent findings in terms of mortality and clinical response or clinical failure. The systematic review examining chronic obstructive pulmonary disease reported that fluoroquinolones had high clinical cure rates with median rates of adverse effects, although the limited evidence describing this indication is an important consideration. One cost-effectiveness study related to pneumonia was identified and no evidence regarding the cost-effectiveness of fluroquinolone use in chronic obstructive pulmonary disease exacerbations was identified. The one included cost-effectiveness study concluded that beta-lactam monotherapy is the preferred empirical treatment for patients hospitalized with community acquired pneumonia in the Netherlands; however the limited volume and generalizability of this evidence is an important consideration. Four guidelines were identified; two informing the treatment of pneumonia and two informing the treatment of chronic obstructive pulmonary disease. The pneumonia-related guidelines stated the following recommendations: health professionals should not routinely offer patients with low-severity community-acquired pneumonia a fluoroquinolone or a dual antibiotic therapy, and a regimen including levofloxacin, among other antibiotics, that has coverage for methicillin-sensitive S. aureus, is recommended for the treatment of clinically suspected ventilator-associated pneumonia and hospital-acquired pneumonia. The chronic obstructive pulmonary disease related guidelines recommended that fluoroquinolones should be used for specific populations of patients such as those who are critically ill, or at higher risk of treatment failure. Low quality evidence was generally utilized in the formulation of the guideline recommendations.The clinical effectiveness, cost-effectiveness, and appropriate guidelines for use of fluoroquinolones in respiratory tract infections, such as pneumonia and chronic obstructive pulmonary disease, remain unclear due to the quality, quantity, and variable results of the identified evidence.