Atypical pneumonia in the Nordic countries: aetiology and clinical results of a trial comparing fleroxacin and doxycycline. Nordic Atypical Pneumonia Study Group.
Community-aquired pneumonia caused by atypical bacteria or viruses was studied in a double-blind trial comparing fleroxacin 400 mg od and doxycycline 100 mg bd for 10 days. The aetiology was confirmed in 258 of 411 cases (66%), of which 133 were caused by Mycoplasma spp., Chlamydia spp. or Legionella spp.; 30 patients had viral infection, nine had pneumococcal or Haemophilus influenzae infection and 93 had mixed aetiology. In intention-to-treat analyses clinical response rates in fleroxacin-treated patients were 86% (157/182) and 75% (137/182) 2-8 days and 3-5 weeks after therapy, respectively. Corresponding results with doxycycline were 93% (177/191) and 85% (162/190), respectively. Differences between treatments seemed to be due to the lower activity of fleroxacin compared with doxycycline against mycoplasma and pneumococci. Drug-related adverse events were reported in 39% of 204 fleroxacin patients and in 34% of 207 doxycycline patients. The null hypothesis that fleroxacin was <15% inferior to doxycycline was accepted at early follow-up but rejected at later review.
Ragnar Norrby
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Department of Infectious Diseases, Lund University Hospital, Sweden.
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002690:Chlamydia Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology; D003718:Denmark; D004311:Double-Blind Method; D004318:Doxycycline / Q000009:adverse effects / Q000627:therapeutic use*; D005387:Finland; D016576:Fleroxacin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007055:Iceland; D007876:Legionellosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D008137:Longitudinal Studies; D009177:Mycoplasma pneumoniae / Q000187:drug effects; D009664:Norway; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000139:chemically induced; D013548:Sweden
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D004318:Doxycycline; D016576:Fleroxacin