Comparative Efficacies and Tolerabilities of Intravenous Azithromycin Plus Ceftriaxone and Intravenous Levofloxacin with Step-Down Oral Therapy for Hospitalized Patients with Moderate to Severe Community-Acquired Pneumonia

Zervos, Marcus J.; Mandell, Lionel A.; Vrooman, Peter S.; Andrews, Charles P.; McIvor, Andrew; Abdulla, Ramzan H.; Caprariis, Pascal J. de; Knirsch, Charles; Amsden, Guy W.; Niederman, Michael S.; Lode, H.

doi:10.2165/00151829-200403050-00006

Cited by 46 publications

(60 citation statements)

References 18 publications

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“…Of the included trials, 8 trials included only patients with severe or moderate-to-severe pneumonia. 16,18,19,21,22,28,30,36 Six additional trials enrolled patients with severe pneumonia; 17,26,27,29,33,34 however, the majority of enrolled patients had mild to moderate pneumonia. The guidelines of the American Thoracic Society 37 and Pneumonia Severity Index score class IV and V 38 were mainly used for assessment of severe pneumonia.…”

Section: Included Trialsmentioning

confidence: 99%

“…Data about mortality in the intention-to-treat population were provided in 18 trials [14][15][16][17][18][19]21,22,24,26,27,[29][30][31][32][33][34]36 and ranged from 0% to 7% (mean 2.7%) in the fluoroquinolone groups and from 0.5% to 8% (mean 3.4%) in the comparator groups. Mortality rates were not different between the 2 groups of patients (Figure 2, OR 0.85, 95% CI 0.65-1.12).…”

Section: Mortalitymentioning

confidence: 99%

“…14,15,[19][20][21][26][27][28][31][32][33][34][35][36] Overall, treatment with fluoroquinolones was successful for 84.2% of patients. Treatment with comparator antibiotics was successful for 82.2% of patients.…”

Section: Treatment Successmentioning

confidence: 99%

“…18,22,25,27,31,35 However, they were not more effective in the analysis that included trials funded by pharmaceutical companies (OR 1.13, 95% CI 0.93-1.38). [14][15][16][17][19][20][21]23,24,26,[28][29][30][32][33][34]36 Twelve trials included patients with severe pneumonia; of these, 7 reported data from this population. 16,19,26,27,29,33,34 In this subgroup, fluoroquinolones were more effective than the comparator antibiotics (OR 1.84, 95% CI 1.02-3.29).…”

Section: Treatment Successmentioning

confidence: 99%

“…However, fluoroquinolones were not more effective than comparator antibiotics for treatment of mild to moderate pneumonia (OR 1.22, 95% CI 0.98-1.51) 14,15,17,18,20,[22][23][24][25][26][27][28][29]31 and moderate-to-severe pneumonia (OR 1.43, 95% CI 1.01-2.04). 16,18,19,21,27,28,30,33,36 In 11 trials, fluoroquinolones were administered orally. [14][15][16][17]20,23,24,27,29,[31][32][33] In 3 of these trials, the comparator antibiotics were initially administered intravenously.…”

Section: Treatment Successmentioning

confidence: 99%

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Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials

Vardakas¹,

Siempos²,

Grammatikos³

et al. 2008

Canadian Medical Association Journal

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CMAJ ResearchBackground: We investigated whether the use of respiratory fluoroquinolones was associated with better clinical outcomes compared with the use of macrolides and β-lactams among adults with pneumonia. Methods:We searched PubMed, Current Contents, Scopus, EMBASE, ClinicalTrials.gov and Cochrane with no language restrictions. Two reviewers independently extracted data from published trials that compared fluoroquinolones (levofloxacin, moxifloxacin, gemifloxacin) with macrolides or β-lactams or both. A meta-analysis was performed with the clinical outcomes of mortality, treatment success and adverse outcomes. Results:We included 23 trials in our meta-analysis. There was no difference in mortality among patients who received fluoroquinolones or the comparator antibiotics (OR 0.85, 95% CI 0.65-1.12). Pneumonia resolved in more patients who received fluoroquinolones compared with the comparator antibiotics for the included outcomes in the intention-to-treat population (OR 1.17, 95% CI 1.00-1.36), clinically evaluable population (OR 1.26, 95% CI 1.06-1.50) and the microbiologically assessed population (OR 1.67, 95% CI 1.28-2.20). Fluoroquinolones were more effective than a combination of β-lactam and macrolide (OR 1.39, 95% CI 1.02-1.90). They were also more effective for patients with severe pneumonia (OR 1.84, 95% CI 1.02-3.29), those who required admission to hospital (OR = 1.30, 95% CI 1.04-1.61) and those who required intravenous therapy (OR = 1.44, 15% CI 1.13-1.85). Fluoroquinolones were more effective than β-lactam and macrolide in open-label trials (OR = 1.35, 95% CI 1.08-1.69) but not in blinded randomized controlled trials (OR = 1.13, 95% CI 0.85-1.50).Interpretation: Fluoroquinolones were associated with higher success of treatment for severe forms of pneumonia; however, a benefit in mortality was not evident. A randomized controlled trial that includes patients with severe pneumonia with or without bacteremia is needed.

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Section: Included Trialsmentioning

confidence: 99%

Section: Mortalitymentioning

confidence: 99%

Section: Treatment Successmentioning

confidence: 99%

Section: Treatment Successmentioning

confidence: 99%

Section: Treatment Successmentioning

confidence: 99%

See 3 more Smart Citations

Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials

Vardakas¹,

Siempos²,

Grammatikos³

et al. 2008

Canadian Medical Association Journal

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Are Fluoroquinolones Superior Antibiotics for the Treatment of Community-Acquired Pneumonia?

Albertson

Morrissey

Chan

2012

Curr Infect Dis Rep

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Various guidelines for the antibiotic treatment of community-acquired pneumonia (CAP) are presented that include fluoroquinolone antibiotics. The efficacy of current fluoroquinolone antibiotics in the treatment of CAP is summarized. Healthcare resource utilization and shortened duration of clinical symptoms have been shown in some, but not all of CAP trials utilizing fluoroquinolone antibiotics. Although evidence for both the clinical and microbiological efficacy of fluoroquinolone antibiotics is abundant, no convincing data demonstrates that they are superior to other standard antibiotics included in CAP guidelines.

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Targets for antibiotic and healthcare resource stewardship in inpatient community-acquired pneumonia: a comparison of management practices with National Guideline Recommendations

et al. 2012

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Purpose Community-acquired pneumonia (CAP) is the most common infection leading to hospitalization in the U.S. The objective of this study was to evaluate management practices for inpatient CAP in relation to IDSA/ATS guidelines to identify opportunities for antibiotic and health care resource stewardship. Methods This was a retrospective cohort study of adults hospitalized for CAP at a single institution from April 15, 2008 – May 31, 2009. Results Of 209 cases, 166 (79%) were admitted to a medical ward and 43 (21%) to the intensive care unit (ICU). 61 (29%) cases were candidates for outpatient therapy per IDSA/ATS guidance with a CURB-65 score of 0 or 1 and absence of hypoxemia. 110 sputum cultures were ordered; however, an evaluable sample was obtained in 49 (45%) cases, median time from antibiotic initiation to specimen collection was 11 (IQR 6–19) hours, and a potential pathogen was identified in only 18 (16%). Blood cultures were routinely obtained for both non-ICU (81%) and ICU (95%) cases, but 15 of 36 (42%) positive cultures were false-positive results. The most common antibiotic regimen was ceftriaxone plus azithromycin (182, 87% cases). Discordant with IDSA/ATS recommendations, oral step-down therapy consisted of a new antibiotic class in 120 (66%), most commonly levofloxacin (101, 55%). Treatment durations were typically longer than suggested with a median of 10 (IQR 8 – 12) days. Conclusions In this cohort of patients hospitalized for CAP, management was frequently inconsistent with IDSA/ATS guideline recommendations revealing potential targets to reduce unnecessary antibiotic and health care resource utilization.

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Comparative Efficacies and Tolerabilities of Intravenous Azithromycin Plus Ceftriaxone and Intravenous Levofloxacin with Step-Down Oral Therapy for Hospitalized Patients with Moderate to Severe Community-Acquired Pneumonia

Cited by 46 publications

References 18 publications

Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials

Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials

Are Fluoroquinolones Superior Antibiotics for the Treatment of Community-Acquired Pneumonia?

Targets for antibiotic and healthcare resource stewardship in inpatient community-acquired pneumonia: a comparison of management practices with National Guideline Recommendations

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