Quinolone Antimicrobial Agents and Theophylline

communications to the editor

---4~III.t---- _ _- - - - - - - Communications for this section will be published as space and priorities permit. The comments should not exceed 350 words in length, with a maximum offive references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports of unique educational character. Specific permission to publish should be cited in a covering letter or appended as a postscript.

Quinolone Antimicrobial Agents and Theophylline To the Editor: We reported in the October 1987 1 and February 19892 issues of Chest that some new quinolone antibacterial agents increase serum levels of theophylline. Since then, more than ten new derivatives have been developed or are currently under development. In this issue, we report the interaction of theophylline and four new quinolones, and we propose to classify these quinolones into three groups according to their degree of theophylline interaction. Quinolones newly tested were sparRoxacin (Dainippon Phannaceutical, Osaka, Japan), temaRoxacin (Tanabe Seiyaku, Osaka, Japan), DR-3355 (Daiichi Pharmaceutical, Tokyo), and OPC-17116 (Otsuka Pharmaceutical, Tokushima, Japan). Five healthy male volunteers received a sustained-release preparation of theophylline orally (200 mg twice daily for four days), followed by oral antimicro-

Table I-Influence ofOuinolones on Serum TheophyUine Level

Drug Group I Pipemidic acid Enoxacin Group II Pefloxacin Ciprofloxacin 'Iosufloxacin OPC-17II6 Group III Nor8oxacin Ofloxacin

Lome8oxacin Fleroxacin Sparfloxacin Temafloxacin DR3355

Cmu

AUC

Yoshihito Niki, .'I.D., FC.C.r, Kohji Hashiguchi, A/.l)., Niro Okimoto, Al.D., F.C.C.R, and Binzo Soejima, A/.D., F.C.C.R, Kawasaki Medical School, OkayanUl, Japan Reprint requests: Dr Niki, .577 Matsushima, Kurashiki, Okaiama, japan 701-01

REFERENCES Niki Y, Soejima R, Kawane H, Sumi M, Umeki S. New synthetic quinolone antibacterial agents and serum concentration of theophylline. Chest 1987; 92:663-69 2 Niki Y, Umeki S, Kawane H, Soejima R. The newest quinolone antimicrobial agents and theophylline [letter]. Chest 1989; 95:486

High Adenosine Deaminase Activity in Pleural Effusion due to Psittacosis

Increase in Serum Theophylline Level, % Daily Dose, mg

bial agents for five or seven days. The quinolone doses are shown in Table 1. Only opc-I7II6caused a significant increase in theophylline level on the fifth day of coadministration (Table 1). We already have the results with 13 new quinolones. According to these results, we established a new classification of quinolones by their effects on theophylline metabolism. Group I includes drugs that showed strong effects (more than 40 percent increase in maximal plasma concentration or area under the plasma concentration curve on day 5 or 7) with a high risk of side effects. Group II includes drugs that caused a mild increase in plasma theophylline level (>5 percent but <40 percent) with the possibility of side effects. Group III includes drugs that have no interaction with theophylline.

Patients with Side Effects, %

To the Editor: Determination of adenosine deaminase (ADA) activity in pleural

Huid has been proposed as a means of distinguishing between 1,500 600

400 600

7It 74;

79t 84t

20 40

17; 17;

19; 22t 24; 33t

0 0 0 20

4 11 -13 -4 O§ -10 2

0 0 0 0 0 0 0

23;

450 200

28t

600 600

4 9

600

400 300 600 300

-8

-4 O§ -11 3

*Values obtained on day 5 except as noted. Cmu= maximal plasma concentration; Aue = area under the plasma concentration curve. tp
tuberculous and nontuberculous pleural effusion. Activity values for this enzyme above 43 lUlL have been considered highly sensitive and specific for the diagnosis of tuberculosis.':" Nevertheless, tuberculous pleural effusions with ADA activity be I0\\' this level and nontuberculous effusions with ADA activity above this established limit have been described." \Ve report psittacosis as a new diagnostic possibility when nontuherculous effusions show an ADA activity greater than 43 lUlL. A 59-year-old woman who bred pigeons was hospitalized because of fever, dry cough, diarrhea, and obnubilation during the previous six days. On examination she was febrile, tachycardiac, and tachypneic. Hypophonesis and dullness over the right hemithorax, as well as hepatomegaly without splenomegaly, were noted. Chest radiography showed right consolidation with pleural effusion. Laboratory tests showed an elevated erythrocyte sedimentation rate (123 mmlh [normal, 0 to 20 mmlh]), elevated alkaline phosphatase concentration (570 lUlL [normal, 270 lUlL]), and elevated "'1glutamyl transferase concentration (297 lUlL [normal, 0 to 50 lUlL]). Arterial blood gas analysis revealed that the POz was 65 mm Hg (normal, 80 mm Hg) and the Pco, was 20 mm Hg (normal, 35 to 45 mm Hg), Complete blood cell count and transaminase and CHEST I 101 I 3 I MARCH. 1992

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