[Community-acquired respiratory tract infections. Current data on the efficacy of various classes of antibiotics and antibiotic resistance of the main prevalent bacteria species]

Abstract

Background: The American Thoracic Society regards fluoroquinolones together with macrolides and doxycycline as first choice antibiotics in the empirical treatment of community acquired pneumoniae in non-hospitalized patients, while the Deutsche Gesellschaft für Pneumology only recommends macrolides and doxycycline for these patients.

Material and methods: In order to find out if the German recommendations still adequately reflect the local resistance situation, we analyzed antibiotic resistance of clinically relevant isolates of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis in a multicenter study with special reference to sparfloxacine and ciprofloxacin according to DIN recommendations.

Results: In contrast to other European countries and the USA the prevalence of antibiotic resistance in Germany is low. Betalactam antibiotics were effective against more than 95% of strains of Haemophilus influenzae and Streptococcus pneumoniae. However, 10% of the strains of Streptococcus pneumoniae were resistant to tetracycline and 7% resistant to erythromycin. Resistances against ciprofloxacin and sparfloxacine were not detectable. Of both quinolone antibiotics, sparfloxacine was always more active than ciprofloxacin.

Conclusions: These susceptibility data and the known prevalence of other respiratory tract pathogens such as Chlamydia pneumoniae and Mycoplasma pneumoniae which are sensitive to erythromycin and tetracycline therefore support the recommendations of the Deutsche Gesellschaft für Pneumology. However, newer fluoroquinolones with increased activity against pneumococci may be a helpful alternative for patients with persistent and recurrent exacerbations of respiratory infections and patients with relevant underlying diseases or relevant risk factors.