title: An open-label, randomized comparison of levofloxacin and amoxicillin/clavulanate plus clarithromycin for the treatment of hospitalized patients with community-acquired pneumonia.
abstract: BACKGROUND
  Anti-pneumococcal fluoroquinolone has been used to treat community-acquired pneumonia (CAP) frequently because of its broad antimicrobial spectrum.
  
  
  METHODS
  This randomized, open-label study was conducted in a tertiary teaching hospital. Eligible patients were randomized to levofloxacin 500 mg IV q24h followed by 500 mg orally q24h or a combination of amoxicillin/clavulanate 500 mg/100 mg IV q8h with oral clarithromycin 500 mg q12h and then oral amoxicillin/clavulanate 250 mg/125 mg q8h with oral clarithromycin 500 mg q12h for 7-14 days.
  
  
  RESULTS
  From July 2004 to February 2006, 50 patients were enrolled (levofloxacin, n = 26; combination therapy, n = 24). The clinical response rate in the clinically evaluable population was similar for both groups (78.3% vs. 77.3%; p = 1.000). Levofloxacin had a higher microbiological response rate overall, and for Gram-negative and non-pseudomonas Gram-negative pathogens than the combination therapy but the difference was not statistically significant (60.0% vs. 38.9%, 55.0% vs. 21.0% and 75.0% vs. 25.0%, respectively). The length of hospital stay was similar for both groups (7.4 +/- 3.1 vs. 6.8 +/- 2.1 days; p = 1.000).
  
  
  CONCLUSIONS
  Patients who were admitted to our hospital for CAP were older and had more comorbidities with a much higher incidence of Gram-negative pathogens than in a previous study. Levofloxacin was at least as effective as amoxicillin/clavulanate plus clarithromycin in clinical and microbiological responses. Levofloxacin had a higher microbiological eradication rate than the combination therapy but the difference was not statistically significant. This deserves further study with a larer sample size.
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Ting-Yu
authors.initials: TY
authors.lastname: Lin
authors.forename: Shu-Min
authors.initials: SM
authors.lastname: Lin
authors.forename: Hao-Cheng
authors.initials: HC
authors.lastname: Chen
authors.forename: Chih-Jan
authors.initials: CJ
authors.lastname: Wang
authors.forename: Yu-Min
authors.initials: YM
authors.lastname: Wang
authors.forename: Min-Li
authors.initials: ML
authors.lastname: Chang
authors.forename: Chun-Hua
authors.initials: CH
authors.lastname: Wang
authors.forename: Chien-Ying
authors.initials: CY
authors.lastname: Liu
authors.forename: Horng-Chyuan
authors.initials: HC
authors.lastname: Lin
authors.forename: Chih-Ten
authors.initials: CT
authors.lastname: Yu
authors.forename: Ling-Ling
authors.initials: LL
authors.lastname: Hsieh
authors.forename: Han-Pin
authors.initials: HP
authors.lastname: Kuo
authors.forename: Chien-Da
authors.initials: CD
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use*; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D019980:Amoxicillin-Potassium Clavulanate Combination; D015242:Ofloxacin