Levofloxacin versus ceftriaxone and azithromycin for treating community-acquired pneumonia: a randomized clinical trial study
-
Davood Yadegarynia
,
Shabnam Tehrani
,
Fatemeh Maghsoudi Nejad
,
Fatemeh Shojaeian
,
Amirreza Keyvanfar
Abstract
Background and Objectives: We compared two common antibiotic regimens for the treatment of mild to moderate CAP: levofloxacin versus β-lactam and macrolide combination; in terms of their efficacy and side effects.
Materials and Methods: Patients with mild to moderate CAP were randomized into two groups. Group I received a combination of 1 gram ceftriaxone daily and 500 mg azithromycin daily for 5-7 days. Group II received levofloxacin 750 mg daily for five days. The signs and symptoms, hospitalization length, and the side effects were investigated.
Results: There were 77 and 74 patients in groups I and II. The vital signs of group II were significantly better on the 3rd day of admission, except for the temperature (P=0.09). The O2 saturation of group II was markedly improved on the 5th day of admission (P=0.0061). In terms of clinical symptoms and hospitalization length, group II was considerably better. However, the rate of side effects in both groups was similar (P=0.885).
Conclusion: Hospitalized patients with mild to moderate CAP might take more advantage of fluoroquinolone administration. It could improve the patients' signs and symptoms and reduce hospitalization length, compared with the combination of macrolide and cephalosporin, with the same rate of side effects.
1. Musher DM, Thorner AR. Community-acquired pneumonia. N Engl J Med 2014; 371: 1619-1628.
2. Capelastegui A, España PP, Bilbao A, Gamazo J, Medel F, Salgado J, et al. Study of community-acquired pneumonia: incidence, patterns of care, and outcomes in primary and hospital care. J Infect 2010; 61: 364-371.
3. Brar NK, Niederman MS. Management of community-acquired pneumonia: a review and update. Ther Adv Respir Dis 2011; 5: 61-78.
4. Ott SR, Hauptmeier BM, Ernen C, Lepper PM, Nüesch E, Pletz MW, et al. Treatment failure in pneumonia: impact of antibiotic treatment and cost analysis. Eur Respir J 2012; 39: 611-618.
5. Ramirez JA, Anzueto AR. Changing needs of community-acquired pneumonia. J Antimicrob Chemother 2011; 66 Suppl 3(Suppl 3): iii3-9.
6. Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, et al. Guidelines for the management of adult lower respiratory tract infections‐-Full version. Clin Microbiol Infect 2011; 17 Suppl 6(Suppl 6): E1-59.
7. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious diseases society of America/American thoracic society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44 Suppl 2 (Suppl 2): S27-72.
8. Watkins RR, Lemonovich TL. Diagnosis and management of community-acquired pneumonia in adults. Am Fam Physician 2011; 83: 1299-1306.
9. Rubinstein E, Camm J. Cardiotoxicity of fluoroquinolones. J Antimicrob Chemother 2002; 49: 593-596.
10. Llop CJ, Tuttle E, Tillotson GS, LaPlante K, File Jr TM. Antibiotic treatment patterns, costs, and resource utilization among patients with community acquired pneumonia: a US cohort study. Hosp Pract (1995) 2017; 45: 1-8.
11. Armitage K, Woodhead M. New guidelines for the management of adult community-acquired pneumonia. Curr Opin Infect Dis 2007; 20: 170-176.
12. Klugman KP, Lonks JR. Hidden epidemic of macrolide-resistant pneumococci. Emerg Infect Dis 2005; 11: 802-807.
13. Samadpanah M, Gachkar L, Salarian S, Hadavand F. Nasopharyngeal Colonization and levofloxacin Susceptibility of Streptococcus pneumoniae among Healthcare Workers in a Teaching Hospital in Tehran, Iran. Nov Biomed 2020; 8: 129-134.
14. Azimi T, Maham S, Fallah F, Azimi L, Gholinejad Z. Evaluating the antimicrobial resistance patterns among major bacterial pathogens isolated from clinical specimens taken from patients in Mofid Children's Hospital, Tehran, Iran: 2013-2018. Infect Drug Resist 2019; 12: 2089-2102.
15. Houri H, Tabatabaei SR, Saee Y, Fallah F, Rahbar M, Karimi A. Distribution of capsular types and drug resistance patterns of invasive pediatric Streptococcus pneumoniae isolates in Teheran, Iran. Int J Infect Dis 2017; 57: 21-26.
16. Richards G, Levy H, Laterre P-F, Feldman C, Woodward B, Bates BM, et al. CURB-65, PSI, and APACHE II to assess mortality risk in patients with severe sepsis and community acquired pneumonia in PROWESS. J Intensive Care Med 2011; 26: 34-40.
17. Schroeder MR, Stephens DS. Macrolide resistance in Streptococcus pneumoniae. Front Cell Infect
Microbiol 2016; 6: 98.
18. Hyde TB, Gay K, Stephens DS, Vugia DJ, Pass M, Johnson S, et al. Macrolide resistance among invasive Streptococcus pneumoniae isolates. JAMA 2001; 286: 1857-1862.
19. Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf 2014; 5: 229-241.
20. Bartlett JG, Dowell SF, Mandell LA, File Jr TM, Musher DM, Fine MJ. Practice guidelines for the management of community-acquired pneumonia in adults. Infectious diseases Society of America. Clin Infect Dis 2000; 31: 347-382.
21. Anderson VR, Perry CM. Levofloxacin: a review of its use as a high-dose, short-course treatment for bacterial infection. Drugs 2008; 68: 535-565.
22. Hurst M, Lamb HM, Scott LJ, Figgitt DP. Levofloxacin: an updated review of its use in the treatment of bacterial infections. Drugs 2002; 62: 2127-2167.
23. Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, et al. Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 2001; 163: 1730-1754.
24. Frei CR, Jaso TC, Mortensen EM, Restrepo MI, Raut MK, Oramasionwu CU, et al. Medical resource utilization among community-acquired pneumonia patients initially treated with levofloxacin 750 mg daily versus ceftriaxone 1000 mg plus azithromycin 500 mg daily: a US-based study. Curr Med Res Opin 2009; 25: 859-868.
25. Torres A, Liapikou A. Levofloxacin for the treatment of respiratory tract infections. Expert Opin Pharmacother 2012; 13: 1203-1212.
26. Dunbar LM, Wunderink RG, Habib MP, Smith LG, Tennenberg AM, Khashab MM, et al. High-dose, short-course levofloxacin for community-acquired Pneumonia: a new treatment paradig. Clin Infect Dis 2003; 37: 752-760.
27. File Jr TM, Segreti J, Dunbar L, Player R, Kohler R, Williams RR, et al. A multicenter, randomized study comparing the efficacy and safety of intravenous and/or oral levofloxacin versus ceftriaxone and/or cefuroxime axetil in treatment of adults with community-acquired pneumonia. Antimicrob Agents Chemother 1997; 41: 1965-1972.
28. Noreddin AM, Elkhatib WF. Levofloxacin in the treatment of community-acquired pneumonia. Expert Rev Anti Infect Ther 2010; 8: 505-514.
29. Belforti RK, Lagu T, Haessler S, Lindenauer PK, Pekow PS, Priya A, et al. Association between initial route of fluoroquinolone administration and outcomes in patients hospitalized for community-acquired pneumonia. Clin Infect Dis 2016; 63: 1-9.
30. Yen Y-H, Chen H-Y, Wuan-Jin L, Lin Y-M, Shen WC, Cheng K-J. Clinical and economic impact of a pharmacist-managed i.v-to-p.o conversion service for levofloxacin in Taiwan. Int J Clin Pharmacol Ther 2012; 50: 136-141.
31. Rebuck JA, Fish DN, Abraham E. Pharmacokinetics of intravenous and oral levofloxacin in critically ill adults in a medical intensive care unit. Pharmacotherapy 2002; 22: 1216-1225.
32. Milkovich G. Intravenous-to-oral transition therapy in community-acquired pneumonia: The INOVA health system experience. Pharmacotherapy 2001; 21: 83S-88S.
33. Zambon A, Polo Friz FH, Contiero P, Corrao G. Effect of macrolide and fluoroquinolone antibacterials on the risk of ventricular arrhythmia and cardiac arrest: an observational study in Italy using case-control, case-crossover and case-time-control designs. Drug Saf 2009; 32: 159-167.
34. Metersky ML, Ma A, Houck PM, Bratzler DW. Antibiotics for bacteremic pneumonia: improved outcomes with macrolides but not fluoroquinolones. Chest 2007; 131: 466-473.
35. Raz-Pasteur A, Shasha D, Paul M. Fluoroquinolones or macrolides alone versus combined with β-lactams for adults with community-acquired pneumonia: systematic review and meta-analysis. Int J Antimicrob Agents 2015; 46: 242-248.
2. Capelastegui A, España PP, Bilbao A, Gamazo J, Medel F, Salgado J, et al. Study of community-acquired pneumonia: incidence, patterns of care, and outcomes in primary and hospital care. J Infect 2010; 61: 364-371.
3. Brar NK, Niederman MS. Management of community-acquired pneumonia: a review and update. Ther Adv Respir Dis 2011; 5: 61-78.
4. Ott SR, Hauptmeier BM, Ernen C, Lepper PM, Nüesch E, Pletz MW, et al. Treatment failure in pneumonia: impact of antibiotic treatment and cost analysis. Eur Respir J 2012; 39: 611-618.
5. Ramirez JA, Anzueto AR. Changing needs of community-acquired pneumonia. J Antimicrob Chemother 2011; 66 Suppl 3(Suppl 3): iii3-9.
6. Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, et al. Guidelines for the management of adult lower respiratory tract infections‐-Full version. Clin Microbiol Infect 2011; 17 Suppl 6(Suppl 6): E1-59.
7. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious diseases society of America/American thoracic society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44 Suppl 2 (Suppl 2): S27-72.
8. Watkins RR, Lemonovich TL. Diagnosis and management of community-acquired pneumonia in adults. Am Fam Physician 2011; 83: 1299-1306.
9. Rubinstein E, Camm J. Cardiotoxicity of fluoroquinolones. J Antimicrob Chemother 2002; 49: 593-596.
10. Llop CJ, Tuttle E, Tillotson GS, LaPlante K, File Jr TM. Antibiotic treatment patterns, costs, and resource utilization among patients with community acquired pneumonia: a US cohort study. Hosp Pract (1995) 2017; 45: 1-8.
11. Armitage K, Woodhead M. New guidelines for the management of adult community-acquired pneumonia. Curr Opin Infect Dis 2007; 20: 170-176.
12. Klugman KP, Lonks JR. Hidden epidemic of macrolide-resistant pneumococci. Emerg Infect Dis 2005; 11: 802-807.
13. Samadpanah M, Gachkar L, Salarian S, Hadavand F. Nasopharyngeal Colonization and levofloxacin Susceptibility of Streptococcus pneumoniae among Healthcare Workers in a Teaching Hospital in Tehran, Iran. Nov Biomed 2020; 8: 129-134.
14. Azimi T, Maham S, Fallah F, Azimi L, Gholinejad Z. Evaluating the antimicrobial resistance patterns among major bacterial pathogens isolated from clinical specimens taken from patients in Mofid Children's Hospital, Tehran, Iran: 2013-2018. Infect Drug Resist 2019; 12: 2089-2102.
15. Houri H, Tabatabaei SR, Saee Y, Fallah F, Rahbar M, Karimi A. Distribution of capsular types and drug resistance patterns of invasive pediatric Streptococcus pneumoniae isolates in Teheran, Iran. Int J Infect Dis 2017; 57: 21-26.
16. Richards G, Levy H, Laterre P-F, Feldman C, Woodward B, Bates BM, et al. CURB-65, PSI, and APACHE II to assess mortality risk in patients with severe sepsis and community acquired pneumonia in PROWESS. J Intensive Care Med 2011; 26: 34-40.
17. Schroeder MR, Stephens DS. Macrolide resistance in Streptococcus pneumoniae. Front Cell Infect
Microbiol 2016; 6: 98.
18. Hyde TB, Gay K, Stephens DS, Vugia DJ, Pass M, Johnson S, et al. Macrolide resistance among invasive Streptococcus pneumoniae isolates. JAMA 2001; 286: 1857-1862.
19. Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf 2014; 5: 229-241.
20. Bartlett JG, Dowell SF, Mandell LA, File Jr TM, Musher DM, Fine MJ. Practice guidelines for the management of community-acquired pneumonia in adults. Infectious diseases Society of America. Clin Infect Dis 2000; 31: 347-382.
21. Anderson VR, Perry CM. Levofloxacin: a review of its use as a high-dose, short-course treatment for bacterial infection. Drugs 2008; 68: 535-565.
22. Hurst M, Lamb HM, Scott LJ, Figgitt DP. Levofloxacin: an updated review of its use in the treatment of bacterial infections. Drugs 2002; 62: 2127-2167.
23. Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, et al. Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 2001; 163: 1730-1754.
24. Frei CR, Jaso TC, Mortensen EM, Restrepo MI, Raut MK, Oramasionwu CU, et al. Medical resource utilization among community-acquired pneumonia patients initially treated with levofloxacin 750 mg daily versus ceftriaxone 1000 mg plus azithromycin 500 mg daily: a US-based study. Curr Med Res Opin 2009; 25: 859-868.
25. Torres A, Liapikou A. Levofloxacin for the treatment of respiratory tract infections. Expert Opin Pharmacother 2012; 13: 1203-1212.
26. Dunbar LM, Wunderink RG, Habib MP, Smith LG, Tennenberg AM, Khashab MM, et al. High-dose, short-course levofloxacin for community-acquired Pneumonia: a new treatment paradig. Clin Infect Dis 2003; 37: 752-760.
27. File Jr TM, Segreti J, Dunbar L, Player R, Kohler R, Williams RR, et al. A multicenter, randomized study comparing the efficacy and safety of intravenous and/or oral levofloxacin versus ceftriaxone and/or cefuroxime axetil in treatment of adults with community-acquired pneumonia. Antimicrob Agents Chemother 1997; 41: 1965-1972.
28. Noreddin AM, Elkhatib WF. Levofloxacin in the treatment of community-acquired pneumonia. Expert Rev Anti Infect Ther 2010; 8: 505-514.
29. Belforti RK, Lagu T, Haessler S, Lindenauer PK, Pekow PS, Priya A, et al. Association between initial route of fluoroquinolone administration and outcomes in patients hospitalized for community-acquired pneumonia. Clin Infect Dis 2016; 63: 1-9.
30. Yen Y-H, Chen H-Y, Wuan-Jin L, Lin Y-M, Shen WC, Cheng K-J. Clinical and economic impact of a pharmacist-managed i.v-to-p.o conversion service for levofloxacin in Taiwan. Int J Clin Pharmacol Ther 2012; 50: 136-141.
31. Rebuck JA, Fish DN, Abraham E. Pharmacokinetics of intravenous and oral levofloxacin in critically ill adults in a medical intensive care unit. Pharmacotherapy 2002; 22: 1216-1225.
32. Milkovich G. Intravenous-to-oral transition therapy in community-acquired pneumonia: The INOVA health system experience. Pharmacotherapy 2001; 21: 83S-88S.
33. Zambon A, Polo Friz FH, Contiero P, Corrao G. Effect of macrolide and fluoroquinolone antibacterials on the risk of ventricular arrhythmia and cardiac arrest: an observational study in Italy using case-control, case-crossover and case-time-control designs. Drug Saf 2009; 32: 159-167.
34. Metersky ML, Ma A, Houck PM, Bratzler DW. Antibiotics for bacteremic pneumonia: improved outcomes with macrolides but not fluoroquinolones. Chest 2007; 131: 466-473.
35. Raz-Pasteur A, Shasha D, Paul M. Fluoroquinolones or macrolides alone versus combined with β-lactams for adults with community-acquired pneumonia: systematic review and meta-analysis. Int J Antimicrob Agents 2015; 46: 242-248.
| Files | ||
| Issue | Vol 14 No 4 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v14i4.10231 | |
| Keywords | ||
| Pneumonia; Community-acquired infections; Anti-bacterial agents; Levofloxacin; Ceftriaxone; Macrolides; Clinical trial | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Yadegarynia D, Tehrani S, Maghsoudi Nejad F, Shojaeian F, Keyvanfar A. Levofloxacin versus ceftriaxone and azithromycin for treating community-acquired pneumonia: a randomized clinical trial study. Iran J Microbiol. 2022;14(4):458-465.
