Woodhead M, Blasi F, Ewig S, Huchon G, Leven M, Ortqvist A, Schabert T, Torres A, can der Jeijden G, Werheij TJM. Guidelines for the management of adult lower respiratory tract infection. Eur Respir J 2005; 26:1138-80. http://www.erj.ersjournals.com/contents-by-date.0.shtml Accessed 23.09.14. RATIONALE: Appendices 1, 2 and 3 give a detailed account of the definitions of LRTI, the microbiological aetiologies of LRTI unspecified, community acquired pneumonia, exacerbations of COPD and bronchiectasis and the pharmacodynamic/pharmacokinetic properties of the antibiotics used to treat them. Strep. pneumoniae remains the most commonly isolated pathogen in all of the above except in bronchiectasis. The infective agents causing exacerbations of COPD differ according to the severity of the underlying condition suggesting that more broad spectrum antibiotics are indicated in patients with severe COPD (FEV1< 50%). Antibiotic classes are discussed with reference to their mode of action in terms of time dependent or concentration dependent effect, their tissue penetration and whether they exert a post antibiotic effect. Other factors such as bioavailability are also considered.

Patel SN, McGeer A, Melano R, Tyrrell GJ, Green K, Pillai DR, Low DE. Susceptibility of Strep pneumonia to fluoroquinolones in Canada. Antimicrob. Agents Chemother. 2011, 55(8): 3703. RATIONALE: The article was published by the Canadian Bacterial Surveillance Network looking at isolates of pneumococci received by them between 1998 and 2009. The poor potency of ciprofloxacin against pneumococci is noted and explained by the fact that the parameter that best predicts the efficacy of fluoroquinolones in eradicating pneumococci is the ration of the area under the concentration-time curve (AUC) compared to the minimum inhibitory concentration (MIC) for the organism. At doses used for therapy, ciprofloxacin never achieves the target ratio of 30-40. The authors postulate that this poor potency may be part of the reason for the increasing ciprofloxacin resistance seen in their study as well as the fact that fewer mutations are required for the development of resistance when using ciprofloxacin compared to other fluoroquinolones.

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).