Levofloxacin-Resistant Pneumococcus

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Abstract
Sir—Wortmann and Bennett [1] report the isolation of Streptococcus pneumoniae from the blood and CSF of a patient who had received 4 days of levofloxacin therapy (500 mg orally once daily). In order to assess the likelihood that this might occur in the future, it is important to know the levofloxacin MIC of the pathogen. Pharmocodynamic principles would suggest that strains with levofloxacin MICs of 4–8 µg/mL would be unlikely to be eradicated by the dosage of levofloxacin they used. The authors described “a zone of inhibition of zero” determined by the E-test (AB Biodisk, Piscataway, NJ). The E-test gives a quantitative MIC and is not read in terms of a zone diameter. Could the authors clarify the MIC of the E-test? If indeed there was no inhibition at all around the E-test, are the authors suggesting that the MIC of this strain is ≥32µg/mL, which is the appropriate interpretation of a levofloxacin E-test with no zone of inhibition?

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