Guidelines for the management of patients with community-acquired pneumonia (USA, Canada) prescribe empiric antibiotic therapy for this disease with respiratory fluoroquinolones because of their activity against a wide range of possible pathogens (Streptococcus pneumoniae, strains producing β-lactamase Haemophilus influenzae and atypical pathogens). On the other hand, a number of medical organizations oppose this practice due to the potential development of resistance of S. pneumoniae to fluoroquinolones, and recommend that these antibiotics be prescribed only when penicillin-resistant pneumococci are isolated. Meanwhile, as the research results show, the microbiological data and the spectrum of susceptibility of the pathogen practically do not affect the choice of treatment regimen for community-acquired pneumonia.

In a retrospective comparative analytical study of medical documentation conducted by American scientists, the practice of prescribing fluoroquinolones to patients with community-acquired pneumonia was analyzed taking into account indicators such as cultural studies, the spectrum of sensitivity of pathogens and allergy history data.

In the study of 10,275 cases of community-acquired pneumonia requiring hospitalization and antibiotic therapy, two comparison groups were formed: 1) patients with microbiologically confirmed S. pneumoniae infection (288 patients) and 2) their corresponding by sex, age and severity of the disease in patients for whom the causative agent was not isolated during the analysis of blood culture and sputum (288 patients).

According to the results, microbiological data and allergic history did not significantly affect the choice of antibiotic therapy. Despite the presence of an infection caused by penicillin-sensitive pneumococci and the absence of a history of allergic reactions to β-lactams, treatment with fluoroquinolone was prescribed to patients in the first group with a frequency not lower (26 , 7%) to that of the second group (34.9%, p = 0.401).

According to the researchers, this practice can increase selective pressure and lead to the emergence of a gram-positive and gram-negative flora resistant to fluoroquinolones. In view of the increase in resistance to fluoroquinolones, a critical approach to their use in community-acquired pneumonia should be adopted, especially if, according to microbiological data, another drug with a narrower spectrum of action can be used.