title: Clostridium difficile-associated diarrhoea in patients with community-acquired lower respiratory infection being treated with levofloxacin compared with beta-lactam-based therapy.
abstract: The aim of the study was to compare the incidence of Clostridium difficile-associated diarrhoea (CDAD) following treatment of community-acquired lower respiratory tract infection (LRTI) in hospitalized patients with levofloxacin or a beta-lactam-based therapy. Nine hundred and thirty-eight patients were included in the prospective open-labelled "randomized" trial. This included 490 patients treated with levofloxacin and 448 patients treated with beta-lactams such as cefuroxime or amoxicillin. The overall incidence of CDAD was 3.8%. There was a lower incidence of CDAD (P < 0.01) in the patients treated with levofloxacin (levofloxacin group) (11/490; 2.2%) compared with patients treated with beta-lactams (beta-lactam group) (25/448; 5.6%), particularly with cefuroxime (cefuroxime group) (21/229; 9.2%; P < 0.0001). There was no significant difference (P = 0.6) in the incidence of CDAD between patients treated with levofloxacin or amoxicillin (amoxicillin group) (4/219; 1.8%). Patients in the cefuroxime and amoxicillin groups had a significantly longer duration of treatment than patients in the levofloxacin group. Although previous antibiotic therapy was a significant risk factor for CDAD in each of the groups, previous antibiotic therapy or admission to specific wards in the hospital were not confounding factors when comparing the groups. The levofloxacin group had a significantly shorter duration of hospitalization (mean 11.7 days; P < 0.01) compared with the beta-lactam group (mean 13.3 days), especially compared with the cefuroxime group (mean 16 days; P < 0.0000001). The amoxicillin group (mean 10.5 days) had a shorter duration of stay compared with the levofloxacin group, but this was not found to be statistically significant. Patients with CDAD had a longer duration of hospital stay than those without CDAD (CDAD +ve 25.8 days; CDAD -ve 11.9 days; P < 0.0000001). In conclusion, levofloxacin is less likely to be the cause of CDAD and is associated with a shorter duration of hospital stay compared with beta-lactam-based therapy for LRTI.
authors.affiliation: Departments of Microbiology and Medicine, University Hospital Lewisham, London SE13 6LH, UK. gopal.rao@uhl.nhs.uk
authors.forename: G
authors.initials: G
authors.lastname: Gopal Rao
authors.forename: C S
authors.initials: CS
authors.lastname: Mahankali Rao
authors.forename: I
authors.initials: I
authors.lastname: Starke
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D016360:Clostridioides difficile / Q000187:drug effects* / Q000302:isolation & purification; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000453:epidemiology; D003967:Diarrhea / Q000139:chemically induced / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D064704:Levofloxacin; D008297:Male; D015242:Ofloxacin / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000453:epidemiology; D047090:beta-Lactams
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D064704:Levofloxacin; D015242:Ofloxacin