An open-label, randomized comparison of levofloxacin and amoxicillin/clavulanate plus clarithromycin for the treatment of hospitalized patients with community-acquired pneumonia

Ting Yu Lin, Shu Min Lin, Hao Cheng Chen, Chih Jan Wang, Yu Min Wang, Min Li Chang, Chun Hua Wang, Chien Ying Liu, Horng Chyuan Lin, Chih Ten Yu, Ling Ling Hsieh, Han Pin Kuo, Chien Da Huang

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: Anti-pneumococcal fluoroquinolone has been used to treat community-acquired pneumonia (CAP) frequently because of its broad antimicrobial spectrum. Methods: This randomized, open-label study was conducted in a tertiary teaching hospital. Eligible patients were randomized to levofloxacin 500 mg IV q24h followed by 500 mg orally q24h or a combination of amoxicillin/clavulanate 500 mg/100 mg IV q8h with oral clarithromycin 500 mg q12h and then oral amoxicillin/clavulanate 250 mg/125 mg q8h with oral clarithromycin 500 mg q12h for 7-14 days. Results: From July 2004 to February 2006, 50 patients were enrolled (levofloxacin, n = 26; combination therapy, n = 24). The clinical response rate in the clinically evaluable population was similar for both groups (78.3% vs. 77.3%; p = 1.000). Levofloxacin had a higher microbiological response rate overall, and for Gram-negative and non-pseudomonas Gram-negative pathogens than the combination therapy but the difference was not statistically significant (60.0% vs. 38.9%, 55.0% vs. 21.0% and 75.0% vs. 25.0%, respectively). The length of hospital stay was similar for both groups (7.4 ± 3.1 vs. 6.8 ± 2.1 days; p = 1.000). Conclusion: Patients who were admitted to our hospital for CAP were older and had more comorbidities with a much higher incidence of Gram-negative pathogens than in a previous study. Levofloxacin was at least as effective as amoxicillin/clavulanate plus clarithromycin in clinical and microbiological responses. Levofloxacin had a higher microbiological eradication rate than the combination therapy but the difference was not statistically significant. This deserves further study with a larer sample size.

Original languageEnglish
Pages (from-to)321-332
Number of pages12
JournalChang Gung Medical Journal
Volume30
Issue number4
Publication statusPublished - Jul 1 2007

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Clavulanic Acid
Levofloxacin
Clarithromycin
Amoxicillin
Pneumonia
Length of Stay
Therapeutics
Fluoroquinolones
Tertiary Care Centers
Teaching Hospitals
Sample Size
Comorbidity
Incidence
Population

Keywords

  • Clinical trial
  • Community-acquired pneumonia
  • Elderly
  • Fluoroquinolones
  • Levofloxacin

ASJC Scopus subject areas

  • Medicine(all)

Cite this

An open-label, randomized comparison of levofloxacin and amoxicillin/clavulanate plus clarithromycin for the treatment of hospitalized patients with community-acquired pneumonia. / Lin, Ting Yu; Lin, Shu Min; Chen, Hao Cheng; Wang, Chih Jan; Wang, Yu Min; Chang, Min Li; Wang, Chun Hua; Liu, Chien Ying; Lin, Horng Chyuan; Yu, Chih Ten; Hsieh, Ling Ling; Kuo, Han Pin; Huang, Chien Da.

In: Chang Gung Medical Journal, Vol. 30, No. 4, 01.07.2007, p. 321-332.

Research output: Contribution to journalArticle

Lin, TY, Lin, SM, Chen, HC, Wang, CJ, Wang, YM, Chang, ML, Wang, CH, Liu, CY, Lin, HC, Yu, CT, Hsieh, LL, Kuo, HP & Huang, CD 2007, 'An open-label, randomized comparison of levofloxacin and amoxicillin/clavulanate plus clarithromycin for the treatment of hospitalized patients with community-acquired pneumonia', Chang Gung Medical Journal, vol. 30, no. 4, pp. 321-332.
Lin, Ting Yu ; Lin, Shu Min ; Chen, Hao Cheng ; Wang, Chih Jan ; Wang, Yu Min ; Chang, Min Li ; Wang, Chun Hua ; Liu, Chien Ying ; Lin, Horng Chyuan ; Yu, Chih Ten ; Hsieh, Ling Ling ; Kuo, Han Pin ; Huang, Chien Da. / An open-label, randomized comparison of levofloxacin and amoxicillin/clavulanate plus clarithromycin for the treatment of hospitalized patients with community-acquired pneumonia. In: Chang Gung Medical Journal. 2007 ; Vol. 30, No. 4. pp. 321-332.
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abstract = "Background: Anti-pneumococcal fluoroquinolone has been used to treat community-acquired pneumonia (CAP) frequently because of its broad antimicrobial spectrum. Methods: This randomized, open-label study was conducted in a tertiary teaching hospital. Eligible patients were randomized to levofloxacin 500 mg IV q24h followed by 500 mg orally q24h or a combination of amoxicillin/clavulanate 500 mg/100 mg IV q8h with oral clarithromycin 500 mg q12h and then oral amoxicillin/clavulanate 250 mg/125 mg q8h with oral clarithromycin 500 mg q12h for 7-14 days. Results: From July 2004 to February 2006, 50 patients were enrolled (levofloxacin, n = 26; combination therapy, n = 24). The clinical response rate in the clinically evaluable population was similar for both groups (78.3{\%} vs. 77.3{\%}; p = 1.000). Levofloxacin had a higher microbiological response rate overall, and for Gram-negative and non-pseudomonas Gram-negative pathogens than the combination therapy but the difference was not statistically significant (60.0{\%} vs. 38.9{\%}, 55.0{\%} vs. 21.0{\%} and 75.0{\%} vs. 25.0{\%}, respectively). The length of hospital stay was similar for both groups (7.4 ± 3.1 vs. 6.8 ± 2.1 days; p = 1.000). Conclusion: Patients who were admitted to our hospital for CAP were older and had more comorbidities with a much higher incidence of Gram-negative pathogens than in a previous study. Levofloxacin was at least as effective as amoxicillin/clavulanate plus clarithromycin in clinical and microbiological responses. Levofloxacin had a higher microbiological eradication rate than the combination therapy but the difference was not statistically significant. This deserves further study with a larer sample size.",
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AU - Lin, Ting Yu

AU - Lin, Shu Min

AU - Chen, Hao Cheng

AU - Wang, Chih Jan

AU - Wang, Yu Min

AU - Chang, Min Li

AU - Wang, Chun Hua

AU - Liu, Chien Ying

AU - Lin, Horng Chyuan

AU - Yu, Chih Ten

AU - Hsieh, Ling Ling

AU - Kuo, Han Pin

AU - Huang, Chien Da

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N2 - Background: Anti-pneumococcal fluoroquinolone has been used to treat community-acquired pneumonia (CAP) frequently because of its broad antimicrobial spectrum. Methods: This randomized, open-label study was conducted in a tertiary teaching hospital. Eligible patients were randomized to levofloxacin 500 mg IV q24h followed by 500 mg orally q24h or a combination of amoxicillin/clavulanate 500 mg/100 mg IV q8h with oral clarithromycin 500 mg q12h and then oral amoxicillin/clavulanate 250 mg/125 mg q8h with oral clarithromycin 500 mg q12h for 7-14 days. Results: From July 2004 to February 2006, 50 patients were enrolled (levofloxacin, n = 26; combination therapy, n = 24). The clinical response rate in the clinically evaluable population was similar for both groups (78.3% vs. 77.3%; p = 1.000). Levofloxacin had a higher microbiological response rate overall, and for Gram-negative and non-pseudomonas Gram-negative pathogens than the combination therapy but the difference was not statistically significant (60.0% vs. 38.9%, 55.0% vs. 21.0% and 75.0% vs. 25.0%, respectively). The length of hospital stay was similar for both groups (7.4 ± 3.1 vs. 6.8 ± 2.1 days; p = 1.000). Conclusion: Patients who were admitted to our hospital for CAP were older and had more comorbidities with a much higher incidence of Gram-negative pathogens than in a previous study. Levofloxacin was at least as effective as amoxicillin/clavulanate plus clarithromycin in clinical and microbiological responses. Levofloxacin had a higher microbiological eradication rate than the combination therapy but the difference was not statistically significant. This deserves further study with a larer sample size.

AB - Background: Anti-pneumococcal fluoroquinolone has been used to treat community-acquired pneumonia (CAP) frequently because of its broad antimicrobial spectrum. Methods: This randomized, open-label study was conducted in a tertiary teaching hospital. Eligible patients were randomized to levofloxacin 500 mg IV q24h followed by 500 mg orally q24h or a combination of amoxicillin/clavulanate 500 mg/100 mg IV q8h with oral clarithromycin 500 mg q12h and then oral amoxicillin/clavulanate 250 mg/125 mg q8h with oral clarithromycin 500 mg q12h for 7-14 days. Results: From July 2004 to February 2006, 50 patients were enrolled (levofloxacin, n = 26; combination therapy, n = 24). The clinical response rate in the clinically evaluable population was similar for both groups (78.3% vs. 77.3%; p = 1.000). Levofloxacin had a higher microbiological response rate overall, and for Gram-negative and non-pseudomonas Gram-negative pathogens than the combination therapy but the difference was not statistically significant (60.0% vs. 38.9%, 55.0% vs. 21.0% and 75.0% vs. 25.0%, respectively). The length of hospital stay was similar for both groups (7.4 ± 3.1 vs. 6.8 ± 2.1 days; p = 1.000). Conclusion: Patients who were admitted to our hospital for CAP were older and had more comorbidities with a much higher incidence of Gram-negative pathogens than in a previous study. Levofloxacin was at least as effective as amoxicillin/clavulanate plus clarithromycin in clinical and microbiological responses. Levofloxacin had a higher microbiological eradication rate than the combination therapy but the difference was not statistically significant. This deserves further study with a larer sample size.

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KW - Community-acquired pneumonia

KW - Elderly

KW - Fluoroquinolones

KW - Levofloxacin

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