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Sir,

Assessing the microbiological efficacy of antibiotic treatment against respiratory infections caused by atypical organisms, specifically Chlamydia pneumoniae and Mycoplasma pneumoniae, is difficult. Culturing is difficult and not readily available. There are no validated, commercially available nucleic acid amplification tests for either organism.1 Recently, File et al.2 reported a study comparing 5 day versus 7 day treatment of community-acquired pneumonia with gemifloxacin. They used serology alone to determine whether patients were infected with C. pneumoniae and M. pneumoniae. The authors state in the Methods section that ‘because only serology was used for identification, bacteriological outcome was presumed on the basis of clinical response’. However, under ‘bacteriologic outcomes’, they state that C. pneumoniae and M. pneumoniae were ‘identified’ and refer to ‘eradication’ of these organisms in Table 3. Unfortunately, serology, especially for C. pneumoniae, is not standardized and correlates poorly with identification of the organism by culture or validated PCR.1 As many as 40% to 70% of patients with culture-documented C. pneumoniae infection will remain seronegative.1 Serology does not detect or identify an organism; it indicates possible exposure. We have previously demonstrated in two studies of community-acquired pneumonia in adults, utilizing cultures, that treatment with levofloxacin or moxifloxacin eradicated C. pneumoniae from 80% and 70% of infected patients, respectively.3,4 We also demonstrated poor correlation between serology, using the microimmunofluorescence assay, and culture. However, the patients who were microbiological failures were clinical cures, despite persistence of the organism. In vitro activity does predict in vivo efficacy. The MICs of moxifloxacin and gemifloxacin for C. pneumoniae are very similar.5

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