Comparative efficacy of levofloxacin and ceftriaxone in the treatment of community acquired pneumonia in children

Abstract

Pneumonia is a common cause of mortality and morbidity in under-5 children throughout the world. Globally an estimated 156 million new episodes of pneumonia occur each year in children and 2 million children die from pneumonia each year which is 20 percent of all deaths of children under five years old. Ceftriaxone is a commonly used drug for empiric treatment of community acquired pneumonia (CAP) in children. Levofloxacin may be an adequate option for empiric therapy in treatment of CAP in children because it gives the broad spectrum activity against both bacterial and atypical pathogens causing CAP and studies suggest that it can be safely used in children. This open labeled, randomized, comparative clinical trial was carried out in the Department of Pediatrics, Sylhet MAG Osmani Medical College Hospital, Bangladesh during January, 2011 & December, 2012 to compare the efficacy of levofloxacin and ceftriaxone in the treatment CAP in children. A total 70 cases of CAP were enrolled. 35 cases were allocated to levofloxacin group and another 35 cases to ceftriaxone group. At first the study cases were selected by systematic random sampling. Group allocation to either levofloxacin or ceftriaxone group was done by lottery method. Total duration for receiving study drugs was seven days. Dose of levofloxacin was 10 mg/kg/day children ≥5 years, where as it was 10 mg/kg 12 hourly in 6 months to <5 years age groups. Dose of ceftriaxone was 75 mg/kg/day. Response to treatment was assessed initially after 3 days and also after 7 days by clinical symptoms and signs. Clinical cure rate was determined by disappearance of the clinical signs and symptoms of pneumonia and resolution of radiological findings reported at admission. Clinical responses were categorized as cured and treatment failure. 91.43% cases were cured in levofloxacin group, whereas cure rate of ceftriaxone group was 68.57% which was statistically significant (p = 0.0168). Adverse effects of levofloxacin were found as skin rash in 1 case and vomiting in 2 cases whereas skin rash was found in 1 case in ceftriaxone group. So it can be concluded that levofloxacin is more effective than ceftriaxone in the treatment of CAP in children.

Comparative Efficacy of Levofloxacin Versus Amoxycillin/Clavulanic Acid Combined with Azithromycin in Treatment of Community-Acquired Pneumonia

“…The key factors of the antibiotic class and mode of administration include age, comorbidities, and disease severity (13). Adults who present with suspected CAP get empirical antimicrobial chemotherapy in compliance with relevant national guidelines (12,13).…”

“…The key factors of the antibiotic class and mode of administration include age, comorbidities, and disease severity (13). Adults who present with suspected CAP get empirical antimicrobial chemotherapy in compliance with relevant national guidelines (12,13). For previously healthy patients who have not taken any antibiotics in the three months before presentation, the 2019 American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) both advocate monotherapy with macrolides or doxycycline in outpatient settings.…”

Clinical Trial for Levofloxacin Versus Amoxycillin/Clavulanic Acid Combined With Azithromycin in Treatment of Community Acquired Pneumonia

“…Adults who present with suspected CAP get empirical antimicrobial chemotherapy in accordance with the pertinent national recommendations, with age, comorbidities, and the severity of the disease serving as the main determinants of the antibiotic class and method of administration (Hoque et al, 2013). For previously healthy patients who haven't taken any antibiotics in the three months before presentation, the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) both advocate monotherapy with macrolides or doxycycline in outpatient settings.…”