Resistance to Levofloxacin and Failure of Treatment of Pneumococcal Pneumonia

This report describes four patients with pneumococcal pneumonia in whom empirical treatment with levofloxacin failed. In these patients, the isolates of Streptococcus pneumoniae were resistant to levofloxacin, and in two of them the resistance appeared to have been acquired during the current course of treatment with fluoroquinolones. In four patients empirical treatment failed, and the isolates of S. pneumoniae were resistant to levofloxacin. The emergence of Streptococcus pneumoniae that is resistant to the β-lactam and macrolide antimicrobial drugs has aroused concern about the use of these agents for the empirical treatment of community-acquired pneumonia. 1 Fluoroquinolones with increased activity against S. pneumoniae, such as levofloxacin, moxifloxacin, and gatifloxacin, are now being recommended for the treatment of patients with community-acquired pneumonia whose infection is likely to have been caused by multidrug-resistant strains. 1 – 6 However, there has been relatively little experience with the use of these agents, as compared with the β-lactam and macrolide antimicrobial agents, as monotherapy for community-acquired pneumonia. We describe four patients with . . .