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Clinical and bacteriological efficacies of sitafloxacin against community-acquired pneumonia caused by Streptococcus pneumoniae: nested cohort within a multicenter clinical trial

Abstract

We evaluated the clinical and bacteriological efficacy of oral sitafloxacin (STFX) in clinically diagnosed community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae. Additionally, we cultured these patient samples to test the minimal inhibitory concentrations (MICs) of levofloxacin (LVFX), moxifloxacin (MFLX), STFX, and penicillin G (PCG), as well as identified mutations in the quinolone resistance determinant regions (QRDRs) in LVFX-resistant strains. This study is a nested cohort from a prospective, multicenter clinical trial consisting of 139 patients with community-acquired pneumonia (CAP), from which 72 were included in this study. After diagnosis of CAP caused by S. pneumoniae, STFX (50 mg twice daily, or 100 mg once daily) was orally administered for 7 days. Sixty-five patient sputum samples were then cultured for MIC analysis. In a LVFX-resistant strain that was identified, mutations in the QRDRs of the gyrA, gyrB, parC, and parE genes were examined. Of 72 patients eligible for this study, S. pneumoniae was successfully cultured from the sputum of 65 patients, and only 7 patients were diagnosed by urinary antigen only. Clinical improvement of CAP was obtained in 65 of the 69 clinically evaluable patients (65/69, 94.2 %). Eradication of S. pneumoniae was observed in 62 patients of the 65 bacteriologically evaluable patients (62/65, 95.4 %). Additionally, STFX showed the lowest MIC distribution compared with LVFX, MFLX, and PCG, and no major adverse reactions were observed. STFX treatment in patients with CAP caused by S. pneumoniae was found to be highly effective both clinically (94.2 %) and bacteriologically (95.4 %).

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Acknowledgments

We thank Daiichi Sankyo Co., Ltd., Tokyo, Japan, for providing editorial assistance. This work received financial support from Daiichi Sankyo Co., Ltd., Tokyo, Japan.

Conflict of interest

J.F. has served on speakers’ bureaus for GlaxoSmithKline, Abbott Japan, Boehringer Ingelheim, Pfizer, Astellas, Daiichi Sankyo, and Taisho Toyama. Y.N. has received a speaker’s honorarium and grant support from Daiichi-Sankyo. Y.T. has received a consultation fee from Daiichi Sankyo. A.W. is a consultant to Daiichi-Sankyo, Mitsubishi Tanabe Pharma Corporation, Toyama Chemical, and Otsuka Pharmaceutical. A.W. has received a speaker’s honorarium from MSD Japan, Glaxo SmithKline K.K., Shionogi & Co. Ltd., Daiichi-Sankyo, Taisho Toyama Pharmaceutical, Dainippon Sumitomo Pharma, and Pfizer Japan Inc. and grant support from Astellas Pharmaceutical, Kyorin Pharmaceutical, Shionogi & Co. Ltd., Taisho Pharmaceutical, Toyama Chemical, Daiichi Sankyo, Dainippon Sumitomo Pharmaceutical, Taiho Pharma, and Meiji Seika Pharma. S.H. has received a consultation fee from Daiichi Sankyo and has received a speaker’s honorarium from Daiichi-Sankyo.

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Correspondence to Jiro Fujita.

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Fujita, J., Niki, Y., Kadota, Ji. et al. Clinical and bacteriological efficacies of sitafloxacin against community-acquired pneumonia caused by Streptococcus pneumoniae: nested cohort within a multicenter clinical trial. J Infect Chemother 19, 472–479 (2013). https://doi.org/10.1007/s10156-012-0514-4

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  • DOI: https://doi.org/10.1007/s10156-012-0514-4

Keywords

  • Levofloxacin-resistant Streptococcus pneumoniae
  • Sitafloxacin STFX)
  • Gyrase
  • Topoisomerase IV