New generation fluoroquinolones and the treatment of adults with community-acquired pneumonia.

The new generation fluoroquinolones are active against Streptococcus pneumoniae, and assure an ideal theoretical protection against the main pathogens responsible for community-acquired bacterial pneumonia: Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, and Chlamydia pneumoniae. Reactions as a result of poor tolerability to this group of drugs are rare but nevertheless severe, and this has limited the number of compounds available on the market. Studies carried out on the fluoroquinolones in the treatment of pneumonia have shown a similar efficacy of these drugs compared to that of the reference compounds, with in particular an equivalent microbial eradication rate for Streptococcus pneumoniae. The risk/benefit ratio still has to be evaluated, both on an individual and on an environmental scale: the benefits also have to be assessed in subgroups of at-risk patients, and in cases of infection with penicillin-resistant pneumococci (minimum inhibitory concentration, MIC > 2). The progression of the epidemic of pneumococci that are highly resistant to penicillin G could provide an oppurtunity for the use of these new compounds, which compared to the beta-lactamines and the macrolides are viewed as second-line therapeutic drugs. (C) 2001 Editions scientifiques et medicales Elsevier SAS.