Experience with levofloxacin in a critical pathway for the treatment of community-acquired pneumonia.
Community-acquired pneumonia (CAP) is associated with considerable morbidity and mortality in both developed and developing countries. Despite research into the optimal management of this condition, there remains great variation in how patients with CAP are treated. A study was performed to assess the results of CAP treatment using a clinical pathway that incorporated admission guidelines, standard treatment orders with oral levofloxacin or cefuroxime axetil plus azithromycin, and an algorithm for oxygen therapy and discharge. The study involved seven centers enrolling 7,734 patients, 55% of whom were treated as outpatients and the remainder were admitted. Overall mortality was 8%, and increasing severity of illness, as assessed by pneumonia severity risk score, was associated with early mortality (within five days of admission) and late mortality (five or more days following admission). The use of the clinical pathway was associated with a reduction in early mortality. The use of levofloxacin alone or with cefuroxime axetil plus azithromycin was associated with decreased mortality compared with the use of other antibiotics.
Department of Medicine, University of Alberta, Edmonton, Alberta T6G 2B7, Canada. tom.marrie@ualberta.ca
Thomas J
TJ
Marrie
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000890:Anti-Infective Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D002444:Cefuroxime / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D019091:Critical Pathways; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006801:Humans; D064704:Levofloxacin; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use*; D010102:Oxygen Inhalation Therapy; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000401:mortality; D011014:Pneumonia / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D064704:Levofloxacin; D017963:Azithromycin; D015242:Ofloxacin; D002444:Cefuroxime