A randomized, open, multicenter clinical study on the short course of intravenous infusion of 750 mg of levofloxacin and the sequential standard course of intravenous infusion/oral administration of 500 mg of levofloxacin for treatment of community-acquired pneumonia

Zhao, Tianyun; Chen, Liangan; Wang, Ping; Tian, Guizhen; Ye, Feng; Zhu, Hao; He, Bei; Baiying, Zhang; Shao, Chen; Zhang, Jie; Gao, Xiwen; Wang, Dongxia; Song, Weidong; Pan, Zhijie; Jin, Chen; Zhang, Xingyi; Gao, Zhancheng; Chen, Ping; Liu, You-ning

doi:10.21037/jtd.2016.08.30

Cited by 15 publications

(27 citation statements)

References 18 publications

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“…Further evaluation could not be performed, as studies with 3-day short-course treatment did not provide data on mortality. Lastly, data on the pharmacokinetic/pharmacodynamic (PK/PD) properties of the antibiotic used are also necessary to specify the optimal treatment for CAP (27).…”

Section: Discussionmentioning

confidence: 99%

“…Concerning the microbiological causes of pneumonia, Streptococcus pneumoniae was the most prevalent pathogen in 9 studies (9,10,14,15,17,18,(26)(27)(28) and Mycoplasma pneumoniae was the most prevalent in 6 studies (13,20,(22)(23)(24)(25). Chlamydophila pneumoniae (12,29), Haemophilus influenzae (19), and Staphylococcus aureus (11) were the most common pathogens in the remaining studies.…”

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confidence: 99%

“…The scoring system for assessing the risk for mortality in pneumonia. 12), a fluoroquinolone antibiotic in 3 studies (levofloxacin for 5 days [13,27] or gemifloxacin for 5 days [15]), amoxicillin for 3 days in 1 study (14), ceftriaxone for 5 days in 1 study (18), and telithromycin for 5 days in 1 study (26). Five studies included antibiotics that are not approved by the Food and Drug Administration (FDA) (singledose azithromycin microspheres [11,12], telithromycin [26], josamycin [10], and roxithromycin [23]).…”

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confidence: 99%

“…Adverse events. Nine clinical trials reported data on the total adverse events that occurred during the study period (9,14,17,18,20,23,(25)(26)(27), and 12 studies reported data on antibiotic-related adverse events (11-13, 15, 17-20, 23, 25-27). Among these studies, 7 provided data on serious adverse events (11-13, 15, 18, 20, 26).…”

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confidence: 99%

“…effort to investigate whether there is an optimal short-course treatment duration, no difference was found in clinical cure (87.6% versus 85% and 89.5% versus 90.4%, respectively) (916 patients, RR ϭ 1.01 [95% CI, 0.97 to 1.07], P ϭ 0.18, and I 2 ϭ 31% for 3 versus Ն7 days and 2,379 patients, RR ϭ 0.99 [95% CI, 0.97 to 1.02], P ϭ 0.97, and I 2 ϭ 0% for 5 versus Ն7 days). With respect to relapse among patients who received FDA-approved treatments, short-course treatment was defined as 3 days in 3 studies (14,19,20) and as 5 days in the other 3 studies (13,17,27) which provided relevant data. When those groups of studies were pooled separately, no difference in relapse rates between short-and FIG 5 Forest plot depicting the risk ratios of antibiotic-related adverse events for patients receiving antibiotic treatment for Յ6 days versus Ն7 days in clinical trials, stratified by duration of therapy.…”

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confidence: 99%

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Systematic Review and Meta-analysis of the Efficacy of Short-Course Antibiotic Treatments for Community-Acquired Pneumonia in Adults

Tansarli

Mylonakis

2018

Antimicrob Agents Chemother

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The duration of therapy for community-acquired pneumonia (CAP) remains undefined. We sought to investigate whether short-course antibiotic treatment for CAP is associated with favorable clinical outcomes in adult patients. We systematically searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for studies comparing the effectiveness and safety between treatment regimens administered for ≤6 days and ≥7 days. We defined treatment for ≤6 days as short-course treatment and treatment for ≥7 days as long-course treatment. Twenty-one clinical trials (4,861 clinically evaluable patients) were included, and 19 out of 21 trials were randomized. Clinical cure was similar between the compared groups (4,069 patients, risk ratio [RR] = 0.99 [95% confidence interval {CI}, 0.97 to 1.01]), irrespective of patient setting (RR = 0.98 [95% CI, 0.96 to 1.00] for the outpatient setting and RR = 1.00 [95% CI, 0.92 to 1.09] for the inpatient setting) or severity of pneumonia (RR = 1.05 [95% CI, 0.96 to 1.14]). Also, relapses were similar between the short- and long-course treatment groups (1,923 patients, RR = 0.67 [95% CI, 0.30 to 1.46]). Short-course treatment was associated with fewer serious adverse events (1,923 patients, RR = 0.73 [95% CI, 0.55 to 0.97]) and, importantly, resulted in lower mortality than long-course treatment (2,802 patients, RR = 0.52 [95% CI, 0.33 to 0.82]). In CAP, short-course antibiotic treatment (≤6 days) is as effective as and potentially superior to, in terms of mortality and serious adverse events, longer-course treatment.

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Section: Discussionmentioning

confidence: 99%