Originally posted by bytestream:.
Comments 0. However, when either of these parameters was large, variation in the other parameter resulted in large changes in the likelihood of clinical failure. With levofloxacin, concentrations in ELF are higher than those in serum and may mitigate against the concern with regard to its lower AUC: Article Contents.
This creates some methodologic difficulties and, therefore, controversy in establishing consistent end points. Resistance data from all 3 sources were based on susceptibility testing using broth microdilution methods, as recommended by the Clinical and Laboratory Standards Institute [ 26 ].
In an IVPM, if concentrations of a given quinolone remained in the mutant selection window i. Fatal meningitis due to levofloxacin resistant Streptococcus pneumoniae.
Diseases of the respiratory system: We explored the impact on projected clinical failure associated with uncertainty in other model parameters. In the animal models, although the minimal AUC: The excess risks associated with empirical outpatient treatment of older individuals and those associated with underlying medical comorbidities are likely to be even higher. We identified 3 types of failure that are clinically relevant and that can be measured in clinical trials and observational studies: The derivation of this model is presented in detail in [Appendix A online only.
However, few efforts have been made to rationalize such threshold recommendations or to explicitly link rates of antimicrobial resistance to clinical outcomes. We estimated the risk of clinical failure as a function of the likelihood and impact of discordant therapy and of the probability of clinical failure even in the presence of optimal therapy.
Our descriptive model is subject to some limitations and would benefit from future research into the natural history of CAP and the impact of antimicrobial therapy.
However, it is reasonable to note that equivalent or smaller absolute increases in risk have been associated with the curtailed or discontinued use of other pharmaceutical agents [ 38 , 39 ].
Fisman; At the Threshold: The probability that a standard dose of levofloxacin i.
The impact of macrolide resistance on clinical failure in CAP is likely to result predominantly from resistance in S. Financial support.