Levofloxacin in the treatment of pneumonia in intensive care unit patients.
In this study, we analyzed 302 patients with pneumonia admitted to the Intensive Care Unit (ICU) who were treated with levofloxacin (LFX) either as monotherapy or combined therapy. Pneumonia was classified as community-acquired in 220 (73%) patients, extra-ICU nosocomial-acquired in 43 (14%), and intra-ICU nosocomial-acquired in 39 (13%) patients. Treatment with LFX was used empirically in 85.7% of the cases. Initial doses of LFX were 500 mg every 24 h in 48.5% of the cases and 500 mg every 12 hours in 48.3%. Treatment was maintained for a mean (SD) of 12.6 (21.9) days. Treatment began as monotherapy in 116 (38.4%) patients and as combination therapy in 186 (61.6%). The factors that influenced the choice of combined treatment were septic shock (odds ratio [OR] 3.03; 95% confidence interval [CI] 1.50-6.12) and the presence of two or more extrinsic factors (OR 1.83; 95% CI 1.04-3.23), while young age was a variable associated with monotherapy (OR 0.98; 95% CI 0.96-0.99). An etiological diagnosis was made in 61.6% of the cases. LFX administration was changed from the intravenous route to oral administration in 85 (28.6%) patients. Satisfactory clinical response (cure and improvement) was achieved in 69.4% of the community-acquired pneumonia, in 55.8% of the extra-ICU nosocomial infection, and in 78.3% of the intra-ICU nosocomial infection. The overall mortality rate was 31.5%. Variables associated with death during ICU stay were combined therapy (OR 3.07; 95% CI 1.23-7.65), septic shock (OR 3.49; 95% CI 1.30-9.39), or therapeutic failure (OR 32.6; 95% CI 13.5-78.9). A total of 15% of the patients experienced adverse effects possibly or probably related the antibiotic given.
Alvarez-Lerma
F
F
Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, Spain. Falvarez@imas.imim.es
Palomar
M
M
Olaechea
P
P
León
C
C
Sanchez
M
M
Bermejo
B
B
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy; D016638:Critical Illness; D003428:Cross Infection / Q000188:drug therapy; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use*; D011014:Pneumonia / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D015242:Ofloxacin