Levofloxacin treatment failure in a patient with fluoroquinolone-resistant Streptococcus pneumoniae pneumonia

Michael B. Kays, David W. Smith, Matthew F. Wack, Gerald Denys

Research output: Contribution to journalShort survey

85 Citations (Scopus)

Abstract

The frequency of fluoroquinolone-resistant Streptococcus pneumoniae has increased as fluoroquinolone administration for treatment of respiratory tract infections has increased. Levofloxacin treatment failed in a patient who had pneumococcal pneumonia and had received three previous courses of levofloxacin therapy. Susceptibility testing revealed high-level resistance to levofloxacin (minimum inhibitory concentration [MIC] > 32 μg/ml), and cross-resistance to moxifloxacin (MIC 4 μg/ml), trovafloxacin (6 μg/ml), and gatifloxacin (12 μg/ml). Sequencing of the quinolone-resistance determining region revealed a mutation of serine-81 to phenylalanine (Ser81→Phe) in the gyrA region of DNA gyrase and a Ser79→Phe mutation in the parc region of topoisomerase IV. The patient was treated successfully with intravenous ceftriaxone followed by oral cefprozil. Clinicians must be aware of local resistance patterns and the potential for fluoroquinolone treatment failures in patients with infections caused by S. pneumoniae.

Original languageEnglish (US)
Pages (from-to)395-399
Number of pages5
JournalPharmacotherapy
Volume22
Issue number3 II
StatePublished - Mar 19 2002

Fingerprint

Levofloxacin
Fluoroquinolones
Streptococcus pneumoniae
Treatment Failure
Pneumonia
Microbial Sensitivity Tests
DNA Topoisomerase IV
DNA Gyrase
Pneumococcal Pneumonia
Pneumococcal Infections
Mutation
Ceftriaxone
Quinolones
Phenylalanine
Respiratory Tract Infections
Serine
Therapeutics

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

Levofloxacin treatment failure in a patient with fluoroquinolone-resistant Streptococcus pneumoniae pneumonia. / Kays, Michael B.; Smith, David W.; Wack, Matthew F.; Denys, Gerald.

In: Pharmacotherapy, Vol. 22, No. 3 II, 19.03.2002, p. 395-399.

Research output: Contribution to journalShort survey

Kays, Michael B. ; Smith, David W. ; Wack, Matthew F. ; Denys, Gerald. / Levofloxacin treatment failure in a patient with fluoroquinolone-resistant Streptococcus pneumoniae pneumonia. In: Pharmacotherapy. 2002 ; Vol. 22, No. 3 II. pp. 395-399.
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