Management of community-acquired lower respiratory tract infections: gemifloxacin; a new economic paradigm

Gary Patou, Glenn Tillotson and Joseph Blondeau

Lower respiratory tract infections account for over 50 million deaths globally each year. They exert a growing clinical and financial burden on healthcare systems and employers. The increasing prevalence of antimicrobial resistance among usual bacterial pathogens over the last decade further drives this burden of disease. Typically species such as Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis exhibit differing, but still growing, resistance phenotypes. The impact of resistance has only recently been fully appreciated with clinical failures to many first-line agents being reported, as well as eminent groups acknowledging the financial impact of bacterial resistance. As resistance continues to emerge it is recognized that a successful clinical outcome depends on several factors including the patient, selection of appropriate drug and the local epidemiology of the likely pathogen. Treatment failures will lead to repeat physician visits, extra diagnostic and laboratory tests, further therapies and possibly hospitalization. The latter has been shown to be a major driver of infectious disease healthcare costs. Targeting the pathogen with the most effective antimicrobial in an appropriately selected patient should optimize both clinical and microbiological success while maximizing economic outcomes. The new fluoroquinolones have been developed to meet these new demands. Gemifloxacin is the latest fluoroquinolone to be approved for the treatment of community acquired respiratory tract infections and acute bacterial exacerbations of chronic bronchitis. Gemifloxacin is a dual targeting fluoroquinolone with in vitro activity against DNA gyrase (topoisomerase II) and topoisomersase IV and has been shown to have potent in vitro activity against S.pneumoniae including both multidrug-resistant phenotypes and many fluoroquinolone-resistant strains. Additionally gemifloxacin is active against other clinically important Gram-positive cocci, Gram-negative and atypical human pathogens.