Gatifloxacin in the treatment of community-acquired pneumonias: a comparative trial of ceftriaxone, with or without macrolides, in hospitalized adult patients with mild to moderately severe pneumonia

Abstract

Community-acquired pneumonia is very common, but some of the cases do require hospitalization for treatment, particularly when older patients and/or co-morbidities are involved; both "typical" and "atypical" respiratory pathogens take part etiologically, and there is increasing concern about the emergence of resistance. There is interest in therapeutic options that can: a) comprehend such a spectrum of bacteria and resistance; b) allow parenteral to oral sequential treatment. We made a multicenter, prospective and randomized trial to compare the "standard" treatment of ceftriaxone IV alone or in combination with erythromycin IV, followed by clarithromycin PO (ceftriaxone treatment arm), with gatifloxacin IV, followed by oral administration (gatifloxacin treatment arm). The need for hospitalization was based on clinical criteria as judged by the investigators. Standardized criteria for diagnosis and follow-up were employed. Fifty-six patients were enrolled, with 48% over 65 years old, and there were frequent co-morbidities. Of these, 51 were clinically evaluable, 26 in the gatifloxacin and 25 in the ceftriaxone arm, with comparable success rates, 92% and 88%, respectively, even when major prognostic factors were considered. There were no serious adverse events or significant laboratory value changes attributable to the study drugs. Gatifloxacin as monotherapy (initially IV then orally until completion of treatment) was shown to be effective and safe, comparable to ceftriaxone IV alone or in combination with a macrolide (initially IV then orally until completion of treatment), in empirical therapy for community-acquired pneumonias, for patients that, at the physician's discretion, require initial treatment as inpatients.

A systematic review of acute and emergency care interventions for adolescents and adults with severe acute respiratory infections including COVID-19 in low- and middle-income countries

“…Nine of the 15 studies evaluated antibiotic regimens. Four of the eight RCTs evaluating antibiotics found no difference in clinical efficacy when comparing the following antibiotic regimens: gatifloxacin vs ceftriaxone (92% and 88% cure rate; P -value not reported), biapenem vs meropenem (94.7% vs 93.75% clinical efficacy; P -value not reported), levofloxacin five day vs seven day course (cure rate 56% vs 56.8%; difference = -0.8; 95% CI = -13.9 to 12.3) and levofloxacin vs ceftriaxone with azithromycin (hospital LOS 3.3 vs 3.4; P = 0.15) [ 59 , 61 , 63 , 64 ]. Abengowe et al [ 57 ] found higher cure rates (68.2% vs 36.5%; P < 0.01) with TMP-SMX over tetracycline in Nigeria, and Chaudhary et al [ 58 ] found benefit for ceftazidime-tobramycin over ceftriaxone in India (88.4% vs 61.2%; P -value not reported), although with high risk of bias.…”

A comprehensive guide for managing antibiotic therapy in pediatric pneumonia

“…WHO created standardized case management guidelines (IMCI), which suggest that children with severe pneumonia, which is determined by the presence of lower chest wall indrawing (LCI), be admitted to a hospital and treated with parenteral antibiotics (penicillin G or ampicillin) (World Health Organization 2005a). This will help decrease child mortality from pneumonia and rationalize antibiotic treatment [83].…”