Levofloxacin 750-mg for 5 days for the treatment of hospitalized Fine Risk Class III/IV community-acquired pneumonia patients.
BACKGROUND
The efficacy and safety of 750-mg, 5-day levofloxacin was recently shown to be comparable to 500-mg, 10-day levofloxacin in a randomized, double-blind, multicentre clinical trial for mild-to-severe community-acquired pneumonia (CAP). This subgroup analysis attempted to compare the safety and efficacy of a short-course levofloxacin regimen with traditional levofloxacin dosing for PSI Class III/IV patients.


METHODS
This retrospective, subgroup analysis focused on Pneumonia Severity Index Class III and IV patients enrolled in the study. Measurements included clinical and microbiological success rates, adverse events, and symptom resolution by day 3 of therapy.


RESULTS
Of the 528 patients in the ITT population, 219 (41.5%) were categorized as PSI Class III/IV and included in this analysis. Among the clinically evaluable patients, 90.8% (69/76) of patients treated with the 750-mg regimen achieved clinical success, compared with 85.5% (71/83) treated with 500-mg levofloxacin (95% CI,-15.9 to 5.4). Eradication rates in the microbiologically evaluable population were comparable for the 750- and 500-mg regimens (88.9% vs 87.5%, respectively; 95% CI,-18.3 to 15.6). Both regimens were well tolerated and had comparable safety profiles. A greater proportion of patients in the 750-mg treatment group experienced resolution of fever (48.4% vs 34.0%; P=.046) and purulent sputum (48.4% vs 27.5%; P=.007) by day 3 of therapy.


CONCLUSIONS
The 750-mg, 5-day levofloxacin course achieved comparable clinical and microbiologic efficacy to the 500-mg, 10-day regimen. By day 3 of therapy, a greater proportion of patients in the 750-mg group had objective and subjective resolution of fever. Further research is needed to determine the economic significance of short-course levofloxacin therapy.
Shorr
Andrew F
AF
Department of Medicine, Pulmonary and Critical Care Medicine, Room 2A-38D, Washington Hospital Center, 110 Irving St. NW, Washington, DC 20010, USA. afshorr@dnamail.com
Khashab
Mohammed M
MM
Xiang
Jim X
JX
Tennenberg
Alan M
AM
Kahn
James B
JB
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016470:Bacteremia / Q000188:drug therapy; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D004334:Drug Administration Schedule; D006760:Hospitalization; D006801:Humans; D064704:Levofloxacin; D008875:Middle Aged; D015242:Ofloxacin / Q000008:administration & dosage* / Q000009:adverse effects; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D015242:Ofloxacin