A controlled, double-blind, multicenter study comparing clarithromycin extended-release tablets and levofloxacin tablets in the treatment of community-acquired pneumonia

Gotfried, Mark H.; Dattani, Dan; Riffer, Ernie; Devcich, Karen J.; Busman, Todd; Notario, Gerard; Palmér, Robert

doi:10.1016/s0149-2918(02)85148-7

Cited by 45 publications

(20 citation statements)

References 16 publications

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“…14,15,19-21, 24,26-28,30,33 The quality of the other 12 studies was low. [16][17][18]22,23,25,29,31,32,[34][35][36] There was no difference in the effectiveness of fluoroquinolones and comparator antibiotics in the trials that were of high quality (OR 1.22, 95% CI 0.95-1.57). In the analysis of lowquality trials, fluoroquinolones were associated with significantly improved treatment success (OR 1.30, 95% CI 1.01-1.67).…”

Section: Quality Assessment and Sensitivity Analysesmentioning

confidence: 96%

“…Five trials included outpatients. 15,20,23,24,33 Both intravenous and oral administration were used depending on the severity of pneumonia and the ability of patients to receive medications orally.…”

Section: Included Trialsmentioning

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%

“…Data about patients with severe pneumonia who received combination therapy or monotherapy were not provided separately. 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.…”

Section: Treatment Successmentioning

confidence: 99%

“…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. 16,17,29 In this subgroup of 11 trials, fluoroquinolones were not more effect-…”

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: Quality Assessment and Sensitivity Analysesmentioning

confidence: 96%

Section: Included Trialsmentioning

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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Antibiotics for community acquired pneumonia in adult outpatients

Bjerre

Verheij

Kochen

2009

Cochrane Database of Systematic Reviews

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Antibiotics for community-acquired pneumonia in adult outpatients

Pakhalé

Mulpuru

Verheij

et al. 2014

Cochrane Database of Systematic Reviews

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BackgroundLower respiratory tract infection (LRTI) is the third leading cause of death worldwide and the first leading cause of death in low-income countries. Community-acquired pneumonia (CAP) is a common condition that causes a significant disease burden for the community, particularly in children younger than five years, the elderly and immunocompromised people. Antibiotics are the standard treatment for CAP. However, increasing antibiotic use is associated with the development of bacterial resistance and side e ects for the patient. Several studies have been published regarding optimal antibiotic treatment for CAP but many of these data address treatments in hospitalised patients. This is an update of our 2009 Cochrane Review and addresses antibiotic therapies for CAP in outpatient settings. ObjectivesTo compare the e icacy and safety of di erent antibiotic treatments for CAP in participants older than 12 years treated in outpatient settings with respect to clinical, radiological and bacteriological outcomes.

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A controlled, double-blind, multicenter study comparing clarithromycin extended-release tablets and levofloxacin tablets in the treatment of community-acquired pneumonia

Cited by 45 publications

References 16 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

Antibiotics for community acquired pneumonia in adult outpatients

Antibiotics for community-acquired pneumonia in adult outpatients

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