Treatment of Community-Acquired Respiratory Tract Infections with Other Antibiotics

Besides the h-lactams, macrolides, and fluoroquinolones, a variety of drugs have been used to treat community-acquired pulmonary infections: the tetracyclines (primarily doxycycline), clindamycin, trimethoprim-sulfamethoxazole, vancomycin, and linezolid. The appearance of strains of Streptococcus pneumoniae resistant to some of these drugs has limited their current use in upper respiratory tract infections, acute exacerbations of chronic bronchitis, and community-acquired pneumonia [1]. Others such as vancomycin have been used primarily in hospitalized patients with severe pneumococcal pneumonia. The optimal dosing of these drugs for respiratory infections is dependent on the drug’s pharmacokinetics and pharmacodynamics (PK/PD) against the infecting pathogens. For upper respiratory tract infections such as sinusitis and otitis media, concentrations in serum are often predictive of efficacy [2]. However, for pulmonary infections, there is increasing evidence that the concentrations in lung secretions, such as epithelial lining fluid (ELF), are very important for determining the outcome of treatment. This chapter will review the current available data on the activity of these drugs against respiratory pathogens and their distribution in respiratory tissues.