Vol.53 No.1 January 2005

The efficacy of tosufloxacin tosilate against with Streptococcus pneumoniae community-acquired pneumonia

Shigeru Kohno¹⁾, Katsunori Yanagihara¹⁾, Atsushi Saito²⁾, Masao Tateyama²⁾, Toshiharu Matsushima³⁾, Yoshihito Niki⁴⁾, Akira Watanabe⁵⁾, Kazunori Tomono⁶⁾, Nobuki Aoki⁷⁾, Hiromoto Shintani⁸⁾, Koichi Nishi⁹⁾, Yasuyuki Sano¹⁰⁾, Naohito Suzuki¹⁰⁾, Hiroshi Sugiura¹¹⁾, Shigetoshi Sakai¹²⁾, Kazuhiro Iizuka¹³⁾, Takashi Ida¹⁴⁾, Hiroshi Hayakawa¹⁵⁾, Ikko Hashizume¹⁶⁾, Akio Tachibana¹⁷⁾, Ken-ichi Arita¹⁸⁾, Niro Okimoto¹⁹⁾, Tadashi Ishida²⁰⁾, Shin Kawahara²¹⁾, Atsuhiko Tada²²⁾, Takeshi Tanimukai²³⁾, Masatoshi Watanabe²⁴⁾, Hirohide Yoneyama²⁵⁾, Yukio Matsumoto²⁶⁾, Yoshiro Sawae²⁷⁾, Masaaki Fukuda²⁸⁾, Koji Hashiguchi²⁸⁾, Sumio Kawamura²⁹⁾, Osamu Sakito³⁰⁾, Yuuichi Inoue³¹⁾, Kin-ichi Izumikawa³²⁾, Kiyoyasu Fukushima³³⁾, Katsumasa Tokunaga³⁴⁾, Yasutsugu Fukuda³⁵⁾, Atsushi Maeda³⁶⁾, Shun-ichi Kinjo³⁷⁾, Mitsuhiko Futenma³⁷⁾, Hajime Ohshiro³⁸⁾, Yuuei Irabu³⁹⁾, Masato Azuma⁴⁰⁾, Taiichi Ohyama⁴¹⁾ and Norifumi Kudeken⁴²⁾

¹⁾Second Department of Internal Medicine, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, Japan
²⁾First Department of Internal Medicine, Faculty of Medicine, University of the Ryukyus
³⁾Center of Respiratory Disease, Kurashiki First Hospital
⁴⁾Division of Respiratory Disease, Department of Internal Medicine, Kawasaki Medicine School
⁵⁾Department of Respiratory Oncology and Molecular Medicine, Institute of Development, Aging and Cancer, Tohoku University
⁶⁾Division of Infection Control, Osaka University Graduate School of Medicine
⁷⁾Department of Internal Medicine, Shinrakuen Hospital
⁸⁾Department of Internal Medicine, Komatsu Municipal Hospital
⁹⁾Division of Respiratory Disease, Ishikawa Prefectural Central Hospital
¹⁰⁾Department of Allergy and Respiratory Disease, Doai Memorial Hospital
¹¹⁾Division of Respiratory Disease, Kugayama Hospital
¹²⁾Department of Internal Medicine, Seibuiruma Hospital, ¹³⁾Iizuka Clinic
¹⁴⁾Department of Internal Medicine, National Hospital Organization, Nakano General Hospital
¹⁵⁾Department of Internal Medicine, National Hospital Organization, Tenryu Hospital
¹⁶⁾Department Respiratory Disease, Hamamatsu Medical Center, ¹⁷⁾Tachibana Clinic
¹⁸⁾Department of Respiratory Disease, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital
¹⁹⁾Division of Respiratory Disease, Department of Medicine, Kawasaki Medical School
²⁰⁾Department of Respiratory Medicine, Kurashiki Central Hospital, ²¹⁾Kawahara Internal Medicine
²²⁾Department of Internal Medicine, National Hospital Organization, Minami-Okayama Medical Center
²³⁾Tanimukai Internal Medicine, ²⁴⁾Inoue Clinic of Internal Medicine
²⁵⁾Department of Internal Medicine, Kasaoka First Hospital
²⁶⁾Department of Infectious Disease, Labour Welfare Corporation San-in Rosai Hospital
²⁷⁾Department of Internal Medicine, Sin-Kokura Hospital
²⁸⁾Department of Respiratory Disease, Japanese Red Cross Nagasaki Atomic Bomb Hospital
²⁹⁾Department of Internal Medicine, Hokushyo Central Hospital
³⁰⁾Department of Internal Medicine, Omura Municipal Hospital
³¹⁾Department of Internal Medicine, Isahaya General Hospital
³²⁾Department of Internal Medicine, Izumikawa Hospital
³³⁾Department of Internal Medicine, Nagasaki Prefectural Tarami Hospital
³⁴⁾Department of Internal Medicine, Ueki Hospital
³⁵⁾Ozaki Internal Medicine, ³⁶⁾Maeda Internal Medicine
³⁷⁾Department Respiratory Disease, Heart-life Hospital, ³⁸⁾Department of Internal Medicine, Okinawa First Hospital
³⁹⁾Department of Internal Medicine, Koza Hospital
⁴⁰⁾Department of Internal Medicine, North Area Medical Associations Hospital
⁴¹⁾Department of Internal Medicine, Oroku Hospital, ⁴²⁾Division of Respiratory Disease, Ryusei Hospital

Abstract

According to the "Japanese Respiratory Society guidelines for the management of community-acquired pneumonia in adults" (hereinafter referred to as "the community-acquired pneumonia guidelines"), fluoroquinolones, such as tosufloxacin tosilate (TFLX) and sparfloxacin (SPFX), are recommended when Streptococcus pneumoniae (S. pneumoniae) is detected. Few clinical studies have been performed, however, of the efficacy and other characteristics of these antimicrobials.
This study examined the efficacy of the fluoroquinolone TFLX against S. pneumoniae-related pneumonia with reference to the community-acquired pneumonia guidelines.
This study included pneumonia patients where the presence of S. pneumoniae was suspected by smear staining (smear staining-positive patients) and, of these positive patients, where S. pneumoniae was actually detected (S. pneumoniae-detected patients). There was no difference in background characteristics between 68 smear staining-positive patients and 36 S. pneumoniae-detected patients. The efficacy rate was 92.6% (25/27 patients) at a daily dose of 450 mg (450-mg group) and 100% (35/35 patients) at 600 mg (600-mg group) in the smear staining-positive patients. The two non-responders at 450 mg had moderate pneumonia. In S. pneumoniae-detected patients, the efficacy rate was 93.6% (15/16 patients) in the 450-mg group and 100% (16/16 patients) in the 600-mg group. S. pneumoniae disappeared in 94.1% (16/17 patients) in the 450-mg group and 93.8% (15/16 patients) in the 600-mg group. Against S. pneumoniae isolated in this study, MIC₉₀ of TFLX was 0.25 μ g/mL. Based on the daily AUC from TFLX concentration in blood from healthy adults, the AUC/MIC ratio was 46.4 in the 450-mg dose and 62.0 in the 600-mg dose.
TFLX was effective against S. pneumoniae-related pneumonia in terms of basic aspects of clinical, antimicrobial and pharmacokinetic properties, showing that TFLX is a respiratory quinolone.
In patients with S. pneumoniae-related pneumonia, TFLX should be administered to patients with mild and moderate pneumonia at a daily dose of 450 or 600 mg. The higher dose of 600 mg is probably preferable in moderate cases with more potent inflammatory responses according to clinical symptoms and laboratory findings.

Key word

tosufloxacin tosilate, TFLX, Streptococcus pneumoniae, community-acquired pneumonia, post marketing surveillance

Received

October 12, 2004

Accepted

January 5, 2005

Jpn. J. Chemother. 53 (1): 11-19, 2005