Treatment of Hospitalized Patients with Pneumonia: Levofloxacin vs. Other Treatment Options | CMAC

Treatment of Hospitalized Patients with Pneumonia: Levofloxacin vs. Other Treatment Options

Clinical Microbiology and Antimicrobial Chemotherapy. 2007; 9(3):268-278

​ Lode H.
antimicrobials pneumonia CAP HAP levofloxacin
Section
Antimicrobials
Type
Journal article
Publication
Clinical Microbiology and Antimicrobial Chemotherapy. 2007; 9(3):268-278

Abstract

Translated and reprinted with permission from «Chemotherapie Journal» 2007; 16:41-8.

The main objective of this study was to compare the efficacy of levofloxacin in hospitalized patients suffering from pneumonia to other antibiotic options by evaluation of clinical data. This meta-analysis includes a retrospective data set based on patient records of hospitalized patients with hospital acquired pneumonia (HAP) or community-acquired pneumonia (CAP) and a prospective data set of a non-interventional observational study on levofloxacin in the treatment of hospitalized CAP patients. A total of 609 patients were included: 261 CAP patients, 112 HAP patients and 236 pneumonia patients without assignment. Levofloxacin was part of the initial antibiotic therapy in 27.8% of the patients. The results of this group were compared to those patients with an initial antibiotic therapy without levofloxacin. These patients most frequently received intravenously a cephalosporin or extended spectrum penicillin. The results indicate a better clinical success in patients being initially treated with levofloxacin: in the total group (84% vs. 66%) and in the subgroups CAP (93% vs. 79%) and HAP (81 % vs. 58%) higher rates of patients with cure or improvement were found as well as lower mortality rates for the patients being treated initially with levofloxacin. An analysis stratified aсcording to type of pneumonia and risk factors before treatment (PSI risk classes) showed, that the higher success rates of the patients being treated initially with levofloxacin were not only the result of an unbalanced risk distribution between treatment groups (adjusted treatment effect: p=0.0121). To eliminate the effect of changes in treatment, the clinical success rates were evaluated separately for patients without change of therapy. The results confirm that even in this subgroup patients being initially treated with levofloxacin had better cure/improvement rates (p=0.0018) and lower mortality rates than patients with initial antibiotic treatment without levofloxacin. The reduction of mean length of hospitalization in patients with initial levofloxacin treatment in comparison to the group with other initial therapy options (CAP 14.7 vs. 17.8 d; HAP 22.7 vs. 31.6 d; total group 17.9 vs. 24.8 d) may be a hint for a pharmacoeconomic impact of an efficacious initial antibiotic treatment including the use of an fluoroquinolon like levofloxacin. Tolerability data were documented only in the prospective data set. In these patients, the good tolerability of levofloxacin is demonstrated by the low incidence of adverse drug reactions in only 1 of 135 patients (0.74%). The results of this meta-analysis confirm that levofloxacin compared to other therapeutic options is a successful and possibly cost efficient initial antibiotic treatment of hospitalized patients with pneumonia.

  • 1. Weite T., Marre R., Suttorp. CAPNetz – Kom-petenznetzwerk ambulant erworbene Pneumonie Strukturen und Ziele. Pneumologie 2003; 57:34-41.
  • 2. Huntemann I., Lorenz J. Ambulant erworbene Pneumonie (AEP), Community Acquired Pneumonia (CAP). CAPNetz. http://www.cap-netz.de/html/pneumonie/cap.pdf.
  • 3. Bodmann K.F. Beatmungsassoziierte Pneumonie – Prävention und Diagnostik. Dtsch Med Wochenschr 2002; 127:744-7.
  • 4. Bodmann K.F., Lorenz J., Bauer T.T., et al. Nosokomiale Pneumonie: Prävention, Diagnostik und Therapie. Chemother J 2003; 12:33-44.
  • 5. Ewig S., Dalhoff K., Lorenz J., et al. Nosokomiale Pneumonie: Empfehlungen zur Therapie und Prophylaxe. Pneumologie 2000; 54:525-38.
  • 6. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcareassociated pneumonia. Am J Respir Crit Care Med 2005; 171:388-416.
  • 7. Höffken G., Lorenz J., Kern W., et al. Epidemiologie, Diagnostik, antimikrobielle Therapie und Management von erwachsenene Patienten mit ambulant erworbenen tiefen Atemwegsinfektionen (akute Bronchitis, akute Exazerbation einer chronischen Bronchitis, Influenza und andere respiratorische Virusinfektionen) sowie ambulant erworbener Pneumonie. S3-Leitlinie der Paul-EhrlichGesellschaft für Chemotherapie e.V., der Deutschen Gesellschaft für Pneumologie, der Deutschen Gesellschaft für Infektiologie und vom Kompetenznetzwerk CAPNETZ. Chemother J 2005; 14:97-155.
  • 8. Fine M.J., Auble T.E., Yealy D.M., et al. A prediction rule to identify low-risk patients with community acquired pneumonia. N Engl J Med 1997; 336:243-50.
  • 9. Marrie T.J., Lau C.Y., Wheeler S.L., et al. A controlled trial of a critical pathway for treatment of communityacquired pneumonia. JAMA 2000; 283:749-55.
  • 10. Carratalä J., Fernändez-Sabe N., Ortega L., et al. Outpatient care compared with hospitalization for community-acquired pneumonia: a randomized trial in lowrisk patients. Ann Intern Med 2005; 142:165-72.
  • 11. Bru J.P., Leophonte .P, Veyssier P. Levofloxacin for the treatment of pneumococcal pneumonia: results of a metaanalysis. Ev Pneumol Clin 2003; 59:348-56.
  • 12. File T.M., Segreti J., Dunbar L., et al. A multicenter, randomized study comparing the efficacy and safety of intravenous and/or oral levofloxacin versus ceftriaxone and/or cefuroxime axetil in treatment of adults with community-acquired pneumonia. Antimicrob Agents Chemother 1997; 41:1965-72.
  • 13. Fogarty C.M., Sullivan J.G., Chattham M.S., et al. Once a day levofloxacin in the treatment of mild to moderate to severe community-acquired pneumonia in adults. Infect Dis In Clin Prac 1998; 7:400-7.
  • 14. Frank E., Liu J., Kinasewitz G., et al. A multicenter, open-label, randomized comparison of levofloxacin and azithromycin plus ceftriaxone in hospitalized adults with moderate to severe community-acquired pneumonia. Clin Ther 2002; 24:1292-308.
  • 15. Shorr A.F., Zadeikis N., Xiang J.X., et al. A multicenter, randomized, double blind, retrospective comparison of 5- and 10-day regimens of levofloxacin in a subgroup of patients aged > or=65 years with community-acquired pneumonia. Clin Ther 2005; 27:1251-9.
  • 16. Shorr A.F., Khashab M.M., Xiang J.X., et al. Levofloxacin 750 mg for 5 days for the treatment of hospitalized Fine Risk Class III/IV community-acquired pneumonia patients. Respir Med 2006; 100:2129-36.
  • 17. Querol-Ribelles J.M., Tenias J.M., Querol-Borras J.M., et al. Levofloxacin versus ceftriaxone plus Clarithromycin in the treatment of adults with community-acquired pneumonia requiring hospitalization. Int J Antimicrob Agents 2005; 25:75-83.
  • 18. Alvarez-Lerma F., Palomar M., Olaechea P., et al., Study group on levofloxacin use in the ICU. Levofloxacin in the treatment of pneumonia in intensive care unit patients. J Chemother 2004; 16:549-56.
  • 19. Carratalä J., Martin-Herrero J.E., Mykietiuk A., GarciaRey C. Clinical experience in the management of community-acquired pneumonia: lessons from the use of fluoroquinolones. Clin Microbiol Infect 2006; 12 (Suppl. 3):2- 11.
  • 20. Mantel N., Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959; 22:719-48.
  • 21. Mehta C.R., Patel N.R., Gray R. On computing an exact confidence interval for the common odds ratio in several 2×2 contingency tables. J Am Statist Assoc 1985; 80:969- 73.
  • 22. Weite T, Nowicki J. Levofloxacin bei nosokomialer Pneumonie. Chemother J 2006; 15:119-22.
Views
0 Abstract
0 PDF
0 Crossref citations
Shared