[Observational study investigating the use of levofloxacin in ICU patients].
BACKGROUND
There is little information on the use of levofloxacin, a new quinolone, in ICU patients.


OBJECTIVE
To investigate the criteria for the use of levofloxacin (indications, forms of prescription, doses, and routes of administration) and to study tolerance in patients admitted to the ICU. Method. Prospective, observational study performed from October 2000 to November 2001 in 35 ICUs and including the first 15 patients receiving levofloxacin as monotherapy or combined treatment. Descriptive data are expressed as mean and percentage. Statistical significance was set at P < .05.


RESULTS
A total of 543 indications for treatment with levofloxacin were analyzed. The patients were 70.7% men, with a mean (SD) age of 60.2 (16.7) years, mean APACHE II score of 18.9 (7.9), and a medical underlying disease in 79.2% of cases. The ICU mortality rate was 24.1%. A total of 60% of patients required mechanical ventilation and 44.3% needed inotropic drug treatment. Levofloxacin was predominantly prescribed for treating community-acquired infections (67.8%), mainly in the respiratory tract (88.1%). An etiological diagnosis was established in only 55.6% of cases. The most common pathogens were Streptococcus pneumoniae (12.7%), Haemophilus influenzae (9.1%), Escherichia coli (7.4%), methicillin-sensitive Staphylococcus aureus (7.2%), Pseudomonas aeruginosa (4.9%), and Legionella pneumophila (4.7%). In 87.1% of indications, levofloxacin was prescribed as empirical treatment. Susceptibility of the isolated pathogens to this antibiotic was confirmed in 32.2% of cases. The initial dose was 500 mg/24 h in 48.5% of indications and 500 mg/12 h in 48.3%. Combined treatment was given in 49.7% of cases. In 32.2% of cases, parenteral administration of levofloxacin was changed to oral route. Adverse events probably or possibly associated with levofloxacin occurred in only 12.5% of patients and mainly included increased ALT/ALS levels (4.4%), diarrhea (2.3%), and heart rhythm alterations (2.1%).


CONCLUSIONS
This study describes the profile of critically ill patients receiving levofloxacin and the different forms of its use in the ICU.
Alvarez-Lerma
Francisco
F
Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, Spain. Falvarez@imas.imim.es
Palomar
Mercedes
M
Olaechea
Pedro
P
León
Cristóbal
C
Sánchez
Miguel
M
Bermejo
Begoña
B
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000382:microbiology; D015897:Comorbidity; D003422:Critical Care / Q000706:statistics & numerical data*; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D003967:Diarrhea / Q000139:chemically induced; D004351:Drug Resistance; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D007362:Intensive Care Units / Q000706:statistics & numerical data; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D012121:Respiration, Artificial; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000382:microbiology; D013030:Spain / Q000453:epidemiology
D000890:Anti-Infective Agents; D064704:Levofloxacin; D015242:Ofloxacin