Pefloxacin therapy for nosocomial infections in the intensive care unit.

Nosocomial infections occurring in an intensive care unit (ICU) are commonly caused by aerobic Gram-negative bacilli or Staphylococcus aureus, which are frequently multi-resistant and difficult to treat and contribute significantly to the patients' morbidity in the ICU. Pefloxacin, with its wide range of antimicrobial activity, lack of serious side-effects and advantageous kinetics, is a useful drug for use in this group of critically ill patients. Pefloxacin has achieved a greater than 70% clinical cure rate and a microbiological response of over 80% in cases of nosocomial pneumonia in the ICU. Failure and superinfection has occurred with the development of resistance, particularly in Pseudomonas aeruginosa in a small number of cases, but this can be prevented by combination antimicrobial therapy. Serious side-effects, including confusion, psychiatric disturbance and other neurological abnormalities were rare and resolved on withdrawal of the drug. Drug interactions occur with cimetidine and theophylline but are usually not clinically relevant; significant interaction with warfarin occurs and the dose of warfarin needs careful adjustment. Pefloxacin is a valuable drug for use in bacteriologically proven sensitive infections and combination with aminoglycosides or beta-lactam agents should prevent the development of resistance.