Pneumococcal resistance to levofloxacin has been identified

In the March issue of the New England Journal of Medicine of Canadian researchers, four cases of pneumococcal pneumonia were described, the treatment of which with levofloxacin proved to be ineffective.

The first case was described by doctors from Mount Sinai Hospital, Toronto. A 64-year-old man, whose Streptococcus pneumoniae sputum sensitive to levofloxacin was isolated, this medication was prescribed (500 mg per day) for 10 days. After 10 days, the patient developed a relapse of pneumonia and, after a second examination, sputum-resistant S. pneumoniae was isolated from the sputum.

In the second case, a 37-year-old woman was prescribed treatment after detecting S. pneumoniae sensitive to levofloxacin. During three days of therapy, the patient's condition did not improve. Repeated sputum analyzes revealed the presence of levofloxacin-resistant S. pneumoniae.

In the third case described, the patient was a 66-year-old woman who had received treatment for community-acquired pneumonia. The patient had a history of chronic obstructive pulmonary disease and chronic leukemia. In addition, she was allergic to penicillins and received ciprofloxacin and levofloxacin due to a previous exacerbation of chronic bronchitis. On the fifth day of levofloxacin treatment for pneumonia, the patient developed septic shock and the next day she died. Subsequent examination showed that the S. pneumoniae strain was initially resistant to levofloxacin.

The last patient, an 80-year-old woman, received levofloxacin for pneumonia that developed after an unsuccessful attempt to treat chronic bronchitis with ciprofloxacin. After 8 days of using levofloxacin, there was no improvement in his condition. Additional therapy was conducted with macrolides. Once again, a sputum test revealed that S. pneumoniae was resistant to levofloxacin.

According to the researchers, serious consideration should be given to introducing the sensitivity of pneumococci to fluoroquinolones in daily medical practice. However, it should be borne in mind that resistance can develop directly during treatment with fluoroquinolones.