A comparison of levofloxacin and moxifloxacin use in hospitalized community-acquired pneumonia (CAP) patients in the US: focus on length of stay

Abstract

This retrospective study suggests that among patients hospitalized with CAP, initial treatment with levofloxacin 750 mg IV is associated with a significantly shorter mean hospital LOS compared with treatment with moxifloxacin 400 mg IV. The clinical implications of a shorter hospital LOS include improved patient and economic outcomes.

Estimating the economic impact of a half-day reduction in length of hospital stay among patients with community-acquired pneumonia in the US

“…This range of savings per half-day reduction in LOS is greater than the $129 reported for the half-day reduction in LOS reported by Schein et al 19 . Those authors did not specifically identify the source of the lower costs, but ascribed them to intangible influences on the cost of hospitalization rather than an accurate reflection of the half-day reduction in LOS.…”

“…Consequently, the estimates of cost-savings based on fixed costs may be a more reliable estimate of the immediate savings that can be expected. The impetus for this analysis was a comparative study of two antibiotics that reported a significant half-day reduction in LOS with one antibiotic relative to the other 19 . However, the results of the current cost analysis are based on published literature reflecting the general CAP population and no imputation is made regarding treatment effects.…”

“…A recent analysis by Schein et al 19 using a US database compared hospital LOS among 797 patients inpatients treated with levofloxacin 750 mg with an equal number of matched CAP patients treated with moxifloxacin 400 mg. The mean hospital LOS was reported to be significantly shorter for patients treated with intravenous levofloxacin 750 mg compared with those treated with intravenous moxifloxacin 400 mg, 5.8 days vs. 6.4 days, respectively, with a least squares mean difference of 0.54 days (p ¼ 0.020).…”

Reply to Mohapatra et al.

“…Mohapatra et al [1] make the point that there have been other studies of the use of fluoroquinolone monotherapy for CAP. However, it should be noted that the study by Schein and colleagues [4], which showed a small reduction (5.8 vs. 6.4 days) in mean length of hospital stay among patients who had received intravenous levofloxacin versus intravenous moxifloxacin during the first 3 days of hospital treatment, was a retrospective database study with no prospective stratification by severity. The study by Leroy et al [5] was an open-label study in which it was concluded that levofloxacin (500 mg every 12 h) was at least as effective as cefotaxime plus ofloxacin for the treatment of CAP in a subset of patients without septic shock who required admission to the intensive care unit.…”

“…Not surprisingly, carbapenems have an essential role in de-escalation strategies, although inappropriate understanding of de-escalation may promote selection of carbapenem-resistant microorganisms [3,4]. At Thammasat University Hospital (Pratumthani, Thailand), the rate of laboratorybased detection of carbapenem-resistant Pseudomonas aeruginosa was 8.7% in 2004 and 13.6% in 2007.…”