A multicenter, open-label, randomized comparison of levofloxacin and azithromycin plus ceftriaxone in hospitalized adults with moderate to severe community-acquired pneumonia

Frank, Elliott; Liu, Jing; Kinasewitz, Gary T.; Moran, Gregory J.; Oross, M.; Olson, William H.; Reichl, Veronica; Freitag, Susan; Bahal, Neelam; Wiesinger, B. A.; Tennenberg, Alan M.; Kahn, Jeff

doi:10.1016/s0149-2918(02)80034-0

Cited by 85 publications

(76 citation statements)

References 14 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%

“…[14][15][16][17][18]20,21,26,27,[29][30][31][32] Isolates recovered from all patients enrolled in the studies were tested for resistance against the study antibiotics and for penicillin resistance. Only one S. aureus isolate resistant to levofloxacin was found in these 13 studies.…”

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%

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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: Included Trialsmentioning

confidence: 99%

Section: Mortalitymentioning

confidence: 99%

Section: Treatment Successmentioning

confidence: 99%

See 2 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

View full text Add to dashboard Cite

show abstract

“…Literatürde F ile AS ± M kullanımının karşılaştırıldığı çalışmalarda gruplar arasında farklı sonuçlar mevcuttur (10-13). F ile AS ± M alan hastaların karşılaştırıldığı birçok çalışmada mikrobiyolojik eradikasyon, semptom kontrolü ve klinik başarı tedavi grupları arasında benzer etkinlikte saptanmıştır (14)(15)(16)(17)(18)(19)(20)(21). Klinik başarı kombinasyon grubunda %79 ile %92, solunum florokinolonları grubunda %79 ile %89 arasında değiştiği görülmüştür.…”

Section: Discussionunclassified