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