title: [Treatment of community-acquired pneumonia with levofloxacin: 500 mg once a day or 500 mg twice a day?].
abstract: LEVOFLOXACIN: A new anti-pneumococcal fluoroquinolone, levofloxacin, has received approval in France for the treatment of community-acquired pneumonia at the dose of 500 mg once or twice a day, depending on the severity of the disease, the germ susceptibility and the patient's weight. Levofloxacin has a powerful and rapid bactericidal activity, particularly against pneumococci, whatever the level of penicillin resistance. The pharmacokinetic properties of the compound allow once daily dosage. Pharmacodynamically, it has been clinically demonstrated that the most predictive parameter of efficacy is the Cmax/MIC ratio. PNEUMOCOCCAL PNEUMONIA: Because of the potential gravity of pneumococcal pneumonia, it might be preferrable to use levofloxacin at the dose of 500 mg twice daily. The efficacy of the two levofloxacin doses for the treatment of pneumococcal pneumonia was thus analyzed. Five clinical studies including 4 comparative trials, enrolling nearly 2,000 patients with community-acquired pneumonia were reported in the international approval document. Among these patients, 310 had documented pneumococcal pneumonia including 31% with bacteriemia. TASK FORCE REPORT: On the basis of available data, the level of proof is sufficient to prescribe levofloxacin at the dose of 500 mg once daily for the treatment of mild to moderately severe community-acquired pneumonia in ambulatory patients, including those with suspected pneumococcal pneumonia, with or without bacteriemia. It would be reasonable to propose the 500 mg twice daily dosage for severe community-acquired pneumonia warranting intensive care hospitalization in accordance with the criteria of the ERS Task Force Report. The well-founded rationale of this therapeutic strategy should be validated by the results of ongoing studies and by following the evolution of germ susceptibility to these new compounds.
authors.affiliation: Service de Pneumologie, Hôpital de Bon Secours, Metz.
authors.forename: P
authors.initials: P
authors.lastname: Zuck
authors.forename: J P
authors.initials: JP
authors.lastname: Bru
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000494:pharmacology; D016470:Bacteremia / Q000382:microbiology; D001835:Body Weight; D002986:Clinical Trials as Topic; D017714:Community-Acquired Infections / Q000188:drug therapy*; D003422:Critical Care; D004334:Drug Administration Schedule; D006801:Humans; D064704:Levofloxacin; D015242:Ofloxacin / Q000008:administration & dosage* / Q000494:pharmacology; D010403:Penicillin Resistance; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy
chemical_list: D000890:Anti-Infective Agents; D064704:Levofloxacin; D015242:Ofloxacin
vernacular_title: Traitement des pneumonies communautaires par lévofloxacine: 500 mg 1 fois par jour ou 500 mg 2 fois par jour?