medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2017-18-65-69medsovet-2034Research ArticleИнфекции в пульмонологииInfections in pulmonologyМЕСТО «РЕСПИРАТОРНЫХ» ФТОРХИНОЛОНОВ В ЛЕЧЕНИИ ВНЕБОЛЬНИЧНОЙ ПНЕВМОНИИ: ФОКУС НА ВЫСОКОДОЗНЫЙ РЕЖИМ ТЕРАПИИ ЛЕВОФЛОКСАЦИНОМPLACE OF RESPIRATORY FLUOROQUINOLONES IN THERAPY OF COMMUNITY ACQUIRED PNEUMONIA: FOCUS ON HIGH-DOSE LEVOFLOXACINE THERAPEUTIC REGIMEСинопальниковА. И.SinopalnikovA. I.

д.м.н., профессор

 MD, Prof

Российская медицинская академия непрерывного профессионального образованияРоссияRussian Medical Academy of Continuous Professional Education of the Ministry of Health of RussiaRussian Federation2017031120170186569Copyright © Синопальников А.И., 20172017Синопальников А.И.Sinopalnikov A.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/2034

Внебольничная пневмония (ВП) относится к числу наиболее распространенных инфекционных заболеваний, в отношении которых нередки диагностические и лечебные ошибки. Назначение антибактериальной терапии больным ВП продолжает оставаться классическим примером «просвещенного эмпиризма» («educated guess»). Сегодня можно найти антибиотики, активные в отношении широкого круга вне- и внутриклеточных возбудителей, способные преодолевать распространенные механизмы резистентности основных респираторных патогенов. Современная практика клинического применения левофлоксацина одновременно демонстрирует и возможности модификации режимов дозирования, безопасное сокращение продолжительности приема лекарственного средства, минимизацию риска селекции лекарственной устойчивости возбудителей заболевания, уменьшение частоты и выраженности нежелательных лекарственных реакций.

 

Community-acquired pneumonia is one of the most prevalent infectious diseases and there are numerous diagnostic and therapeutic mistakes in relation to it. Prescription of the antibiotics to CAP patients remains a classic example of “educated guess”. Today one can find antibiotics active against a large range of intra- and extracellular causative agents able to prolong widely spread mechanism of resistance of major respiratory pathogens. The modern practice of clinical application of levofloxacin simultaneously demonstrates possibilities of modification of dosing regimes, safe reduction of the time of administration of the drug, minimization of the risk of selection of drug resistance of the disease causative agents, reduction of frequency and intensity of drug reactions.

 

внебольничная пневмонияантибиотикотерапияфторхинолонылевофлоксацинcommunity-acquired pneumoniaantibiotic therapyfluoroquinoloneslevofloxacinReferencesFile TM, Marrie TJ. Burden of community-acquired pneumonia in North American adults. Postgrad Med, 2010, 122: 130.File TM, Marrie TJ. Burden of community-acquired pneumonia in North American adults. Postgrad Med, 2010, 122: 130.Mendell LA. Community-acquired pneumonia: an overview. Postgrad Med, 2015, 127: 607-615.Mendell LA. Community-acquired pneumonia: an overview. Postgrad Med, 2015, 127: 607-615.Marrie T. Epidemiology, pathogenesis, and microbiology of community-acquired pneumonia in adults. Available from www.uptodate. com. Last accessed 14 March 2017.Marrie T. Epidemiology, pathogenesis, and microbiology of community-acquired pneumonia in adults. Available from www.uptodate. com. Last accessed 14 March 2017.Mandell LA, Wunderink RG, Anzueto A et al. Infectious Diseases Society of America/ American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clin Infect Dis, 2007, 44: 27-72.Mandell LA, Wunderink RG, Anzueto A et al. Infectious Diseases Society of America/ American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clin Infect Dis, 2007, 44: 27-72.Lim WS, Baudouin SV, George RC et al. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax, 2009, 64(Suppl III): iii1–iii55.Lim WS, Baudouin SV, George RC et al. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax, 2009, 64(Suppl III): iii1–iii55.Чучалин А.Г., Синопальников А.И., Козлов Р.С. и др. Внебольничная пневмония у взрослых: Практические рекомендации по диагностике, лечению и профилактике. Клин микробиол антимикроб химиотер, 2010, 12: 186-226.Чучалин А.Г., Синопальников А.И., Козлов Р.С. и др. Внебольничная пневмония у взрослых: Практические рекомендации по диагностике, лечению и профилактике. Клин микробиол антимикроб химиотер, 2010, 12: 186-226.Pneumonia: Diagnosis and Management of Community- and Hospital-Acquired Pneumonia in Adults. London: National Institute for Health and Care Excellence (UK), 2014 Dec.Pneumonia: Diagnosis and Management of Community- and Hospital-Acquired Pneumonia in Adults. London: National Institute for Health and Care Excellence (UK), 2014 Dec.Thiem U, Heppner HJ, Pientka L. Elderly patients with community-acquired pneumonia. Optimal treatment strategies. Drug Aging, 2011, 28: 519-537.Thiem U, Heppner HJ, Pientka L. Elderly patients with community-acquired pneumonia. Optimal treatment strategies. Drug Aging, 2011, 28: 519-537.Nareddin AM, Elkhatib WF, Cunnion KM, Zhanel GG. Cumulative clinical experience from over a decade of use of levofloxacin in community-acquired pneumonia: critical appraisal and role in therapy. Drug Health Patient Saf, 2001, 3: 59-68.Nareddin AM, Elkhatib WF, Cunnion KM, Zhanel GG. Cumulative clinical experience from over a decade of use of levofloxacin in community-acquired pneumonia: critical appraisal and role in therapy. Drug Health Patient Saf, 2001, 3: 59-68.Odenholt I, Cars O. Pharmacodynamics of moxifloxacin and levofloxacin against Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli: simulation of human plasma concentrations after intravenous dosage in an in vitro model. JAC, 2006, 58: 960-965.Odenholt I, Cars O. Pharmacodynamics of moxifloxacin and levofloxacin against Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli: simulation of human plasma concentrations after intravenous dosage in an in vitro model. JAC, 2006, 58: 960-965.Lister PD. Pharmacodynamics of 750 mg and 500 mg doses of levofloxacin against ciprofloxacin-resistant strains of Streptococcus pneumoniae. Diadn Microbiol Infect Dis, 2002, 44: 43-49.Lister PD. Pharmacodynamics of 750 mg and 500 mg doses of levofloxacin against ciprofloxacin-resistant strains of Streptococcus pneumoniae. Diadn Microbiol Infect Dis, 2002, 44: 43-49.Noreddin AM, Hoban DJ, Zhanel GG. Comparison of gatifloxacin and levofloxacin administered at various dosing regiments tp hospitalised patients with community-acquired pneumonia: pharmacodynamic target attainment study using North American surveillance data for Streptococcus pneumoniae. Int J Antimicrob Agents, 2005, 26: 120-125.Noreddin AM, Hoban DJ, Zhanel GG. Comparison of gatifloxacin and levofloxacin administered at various dosing regiments tp hospitalised patients with community-acquired pneumonia: pharmacodynamic target attainment study using North American surveillance data for Streptococcus pneumoniae. Int J Antimicrob Agents, 2005, 26: 120-125.Gotfried MH, Danziger LH, Rodvold KA. Steady-state plasma and intrapulmonary concentrations of levofloxacin and ciprofloxacin in healthy adult subjects. Chest, 2001, 119: 1114-1122.Gotfried MH, Danziger LH, Rodvold KA. Steady-state plasma and intrapulmonary concentrations of levofloxacin and ciprofloxacin in healthy adult subjects. Chest, 2001, 119: 1114-1122.Cao G, Zhang J, Wu X et al. Pharmacokinetics and pharmacodynamics of levofloxacin injection in healthy Chinese volunteers and dosing regimen optimization. J Clin Pharm Ther, 2013, 38: 394-400.Cao G, Zhang J, Wu X et al. Pharmacokinetics and pharmacodynamics of levofloxacin injection in healthy Chinese volunteers and dosing regimen optimization. J Clin Pharm Ther, 2013, 38: 394-400.Nightingale CH, Grant EM, Quintiliani R. Pharmacokinetics and pharmacodynamics of levofloxacin. Chemotherapy, 2000, 46(Suppl 1): 6-14.Nightingale CH, Grant EM, Quintiliani R. Pharmacokinetics and pharmacodynamics of levofloxacin. Chemotherapy, 2000, 46(Suppl 1): 6-14.Frei CR, Burgess DS. Pharmacodynamic analysis of ceftriaxone, gatifloxacin, and levofloxacin against Streptococcus pneumoniae with the use Monte Carlo simulation. Pharmacotherapy, 2005, 25: 1161-1167.Frei CR, Burgess DS. Pharmacodynamic analysis of ceftriaxone, gatifloxacin, and levofloxacin against Streptococcus pneumoniae with the use Monte Carlo simulation. Pharmacotherapy, 2005, 25: 1161-1167.Козлов Р.С., Сухорукова М.В., Сивая О.В., исследовательская группа ПеГАС. Чувствительность к антимикробным препаратам клинических штаммов Streptococcus pneumoniae, выделенных в различных регионах РФ в 2010–2013 гг. Клин Микробиол Антимикроб Химиотер, 2015, 2 (Приложение 1): 31.Козлов Р.С., Сухорукова М.В., Сивая О.В., исследовательская группа ПеГАС. Чувствительность к антимикробным препаратам клинических штаммов Streptococcus pneumoniae, выделенных в различных регионах РФ в 2010–2013 гг. Клин Микробиол Антимикроб Химиотер, 2015, 2 (Приложение 1): 31.Doern GV, Richter SS, Miller A et al. Antimicrobial resistance among Streptococcus pneumoniae in the United States: have we begun to turn the corner on resistnce to certain antimicrobial classes? Clin Infect Dis, 2005, 41: 139-148.Doern GV, Richter SS, Miller A et al. Antimicrobial resistance among Streptococcus pneumoniae in the United States: have we begun to turn the corner on resistnce to certain antimicrobial classes? Clin Infect Dis, 2005, 41: 139-148.Doern GV, Brown SD. Antimicrobial susceptibility among community-acquired respiratory tract pathogens in the USA: data from PROTEKT US 2000-2001. J Infect, 2004, 48: 56-65.Doern GV, Brown SD. Antimicrobial susceptibility among community-acquired respiratory tract pathogens in the USA: data from PROTEKT US 2000-2001. J Infect, 2004, 48: 56-65.Noreddin AM, Elkhatib WF. Levofloxacin in the treatment of community-acquired pneumonia. Expert Rev Anti Infect Ther, 2010, 8: 505-514.Noreddin AM, Elkhatib WF. Levofloxacin in the treatment of community-acquired pneumonia. Expert Rev Anti Infect Ther, 2010, 8: 505-514.Felmingham D, Feldman C, Hryniewicz W et al. Surveillance of resistance in bacteria causing community-acquired respiratory tract infections. Clin Microbiol Infect, 2002, 8(Suppl. 2): 12-42.Felmingham D, Feldman C, Hryniewicz W et al. Surveillance of resistance in bacteria causing community-acquired respiratory tract infections. Clin Microbiol Infect, 2002, 8(Suppl. 2): 12-42.Козлов Р.С., Сивая О.В., Кречикова О.И. и соавт. Динамика резистентности Streptococcus pneumoniae к антибиотикам в России за период 1999–2009 гг. (Результаты многоцентрового проспективного исследования ПеГАС). Клин Микробиол Антимикроб Химиотер, 2010, 12(4): 329-341.Козлов Р.С., Сивая О.В., Кречикова О.И. и соавт. Динамика резистентности Streptococcus pneumoniae к антибиотикам в России за период 1999–2009 гг. (Результаты многоцентрового проспективного исследования ПеГАС). Клин Микробиол Антимикроб Химиотер, 2010, 12(4): 329-341.Vardakas KZ, Siempos II, Grammatikos A et al. Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials. Can Med Assoc J, 2008, 179: 1269-1277.Vardakas KZ, Siempos II, Grammatikos A et al. Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials. Can Med Assoc J, 2008, 179: 1269-1277.Ye X, Sikirica V, Schein JR et al. Treatment failure rates and health care utilization and costs among patients with community-acquired pneumonia treated with levofloxacin or macrolides in an outpatient setting: a retrospective claims database analysis. Clin Ther, 2008, 30: 358-370.Ye X, Sikirica V, Schein JR et al. Treatment failure rates and health care utilization and costs among patients with community-acquired pneumonia treated with levofloxacin or macrolides in an outpatient setting: a retrospective claims database analysis. Clin Ther, 2008, 30: 358-370.Hess G, Hill JW, Raut MK et al. Comparative antibiotic failure rates in the treatment of community-acquired pneumonia: results from a claims analysis. Adv Ther, 2010, 27: 743-755.Hess G, Hill JW, Raut MK et al. Comparative antibiotic failure rates in the treatment of community-acquired pneumonia: results from a claims analysis. Adv Ther, 2010, 27: 743-755.Simonetti AF, Garcia-Vidal C, Viasus D et al. Declining mortality among hospitalized patients with community-acquired pneumonia. Clin Microbiol Infect, 2016, doi: 10.1016/j. cmi.2016.03.015.Simonetti AF, Garcia-Vidal C, Viasus D et al. Declining mortality among hospitalized patients with community-acquired pneumonia. Clin Microbiol Infect, 2016, doi: 10.1016/j. cmi.2016.03.015.Dunbar LM, Wunderink RG, Habib MP et al. High-dose, short-course levofloxacin for community-acquired pneumonia: a new treatment paradigm. Clin Infect Dis, 2003, 37: 752-760.Dunbar LM, Wunderink RG, Habib MP et al. High-dose, short-course levofloxacin for community-acquired pneumonia: a new treatment paradigm. Clin Infect Dis, 2003, 37: 752-760.Shorr AF, Khashab MM, Xiang JX et al. Levofloxacin 50-mg for 5 days for treatment of hospitalized Fine Risk Class III/IV community-acquired pneumonia patients. Respir Med, 2006, 100: 2129-2136.Shorr AF, Khashab MM, Xiang JX et al. Levofloxacin 50-mg for 5 days for treatment of hospitalized Fine Risk Class III/IV community-acquired pneumonia patients. Respir Med, 2006, 100: 2129-2136.Zhao X, Wu JF, Xiu QY et al. A randomized controlled clinical trial of levofloxacin 750 g versus 500 mg intravenous infusion in the treatment of community-acquired pneumonia. Diagn Microbiol Infect Dis, 2014, 80: 141-147.Zhao X, Wu JF, Xiu QY et al. A randomized controlled clinical trial of levofloxacin 750 g versus 500 mg intravenous infusion in the treatment of community-acquired pneumonia. Diagn Microbiol Infect Dis, 2014, 80: 141-147.Zhao T, Chen L-A, Wang P et al. A randomized, open, multicenter clinical study on the short course of intravenous infusion of 750 mg of levofloxacin and the sequential standard course of intravenous infusion/oral administration 0f 500 mg of levofloxacin for treatment of community-acquired pneumonia. J Thorac Dis, 2016, 8: 2473-2484.Zhao T, Chen L-A, Wang P et al. A randomized, open, multicenter clinical study on the short course of intravenous infusion of 750 mg of levofloxacin and the sequential standard course of intravenous infusion/oral administration 0f 500 mg of levofloxacin for treatment of community-acquired pneumonia. J Thorac Dis, 2016, 8: 2473-2484.Shorr AF, Zadeikis N, Xiang JX et al. A multi-center, randomized, double-blind, retrospective comparison of 5- and 10-day regimens f levofloxacin in a subgroup of patients > or = 65 years with community-acquired pneumonia. Clin Ther, 2005, 27: 1251-1259.Shorr AF, Zadeikis N, Xiang JX et al. A multi-center, randomized, double-blind, retrospective comparison of 5- and 10-day regimens f levofloxacin in a subgroup of patients > or = 65 years with community-acquired pneumonia. Clin Ther, 2005, 27: 1251-1259.www.fda.gov/Drugs/DrugSafety/ucm511530.htm.www.fda.gov/Drugs/DrugSafety/ucm511530.htm.Stahlmann R, Lode HM. Risks associated with the therapeutic use of fluoroquinolones. Expert Opin Drug Saf, 2013, 12: 497-505.Stahlmann R, Lode HM. Risks associated with the therapeutic use of fluoroquinolones. Expert Opin Drug Saf, 2013, 12: 497-505.Lu ZK, Yuan J, Li M et al. Cardiac risks associated with antibiotics: azithromycin and levofloxacin. Expert Opin Drug Saf, 2015, 14: 295-303.Lu ZK, Yuan J, Li M et al. Cardiac risks associated with antibiotics: azithromycin and levofloxacin. Expert Opin Drug Saf, 2015, 14: 295-303.Ball P. Role of levofloxacin in the treatment of lower respiratory tract infections. Penetration: New challenges for levofloxacin in the fight against infectious diseases. Annual Issue 2003. Tokyo: BIOMEDIS, 2003: 22-32.Ball P. Role of levofloxacin in the treatment of lower respiratory tract infections. Penetration: New challenges for levofloxacin in the fight against infectious diseases. Annual Issue 2003. Tokyo: BIOMEDIS, 2003: 22-32.Khashab MM, Xiang J, Kahn JB. Comparison of the adverse event profiles of levofloxacin 500 mg and 750 mg in clinical trials for the treatment of respiratory infections. Curr Med Res Opin, 2006, 22: 1997-2006.Khashab MM, Xiang J, Kahn JB. Comparison of the adverse event profiles of levofloxacin 500 mg and 750 mg in clinical trials for the treatment of respiratory infections. Curr Med Res Opin, 2006, 22: 1997-2006.www.fda.gov/safety/medwatch/safetyinformation/ucm303865.htm.www.fda.gov/safety/medwatch/safetyinformation/ucm303865.htm.Tillotson G, Ball P. Fluoroquinolone safety profiles – A review. Today’s Therapeutic Trends, 2002, 20: 419-435.Tillotson G, Ball P. Fluoroquinolone safety profiles – A review. Today’s Therapeutic Trends, 2002, 20: 419-435.Lipsky BA, Baker CA. Fluoroquinolone toxicity profiles: a rewiew focusing on new agents. Clin Infect Dis, 1999, 28: 352-364.Lipsky BA, Baker CA. Fluoroquinolone toxicity profiles: a rewiew focusing on new agents. Clin Infect Dis, 1999, 28: 352-364.www.accessdata.fda.gov/drugsatfda_docs/label/20 16/020634s067,020635s073,021721s034lbl.pdf.www.accessdata.fda.gov/drugsatfda_docs/label/20 16/020634s067,020635s073,021721s034lbl.pdf.

The authors declare that there are no conflicts of interest present.