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Text
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URL Address
<a href="http://doi.org/10.1097/00019048-199802000-00005" target="_blank" rel="noreferrer noopener">http://doi.org/10.1097/00019048-199802000-00005</a>
Pages
1965–1972
Issue
9
Volume
41
Dublin Core
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Title
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A multicenter, randomized study comparing the efficacy and safety of intravenous and/or oral levofloxacin versus ceftriaxone and/or cefuroxime axetil in treatment of adults with community-acquired pneumonia.
Publisher
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Antimicrobial agents and chemotherapy
Date
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1997
1997-09
Subject
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*Levofloxacin; 80 and over; Administration; Adolescent; Adult; Aged; Anti-Infective Agents/adverse effects/*therapeutic use; Bacterial/*drug therapy/microbiology; Ceftriaxone/adverse effects/*therapeutic use; Cefuroxime/adverse effects/*analogs & derivatives/therapeutic use; Cephalosporins/adverse effects/*therapeutic use; Combination; Community-Acquired Infections/drug therapy/microbiology; Drug Therapy; Female; Humans; Injections; Intravenous; Male; Middle Aged; Ofloxacin/adverse effects/*therapeutic use; Oral; Pneumonia; Prodrugs/adverse effects/*therapeutic use; Prospective Studies; Treatment Outcome
Creator
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File T M Jr; Segreti J; Dunbar L; Player R; Kohler R; Williams R R; Kojak C; Rubin A
Description
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Five hundred ninety patients were enrolled in a prospective, multicenter, randomized trial comparing the efficacy and safety of 7 to 14 days of levofloxacin treatment with that of ceftriaxone and/or cefuroxime axetil in the management of community-acquired pneumonia in adults. Patients received either intravenous and/or oral levofloxacin (500 mg once daily) or the comparative agents, parenteral ceftriaxone (1 to 2 g once to twice daily) and/or oral cefuroxime axetil (500 mg twice daily). Erythromycin or doxycycline could be added to the comparator arm at the investigator's discretion. The decision to use an intravenous or oral antimicrobial agent for initial therapy was made by the investigator. Clinical and microbiological evaluations were completed at the baseline, during treatment, 5 to 7 days posttherapy, and 3 to 4 weeks posttherapy. Four hundred fifty-six patients (226 given levofloxacin and 230 administered ceftriaxone and/or cefuroxime axetil) were evaluable for clinical efficacy. Streptococcus pneumoniae and Haemophilus influenzae were isolated in 15 and 12%, respectively, of clinically evaluable patients. One hundred fifty atypical pathogens were identified: 101 were Chlamydia pneumoniae, 41 were Mycoplasma pneumoniae, and 8 were Legionella pneumophila. Clinical success at 5 to 7 days posttherapy was superior for the levofloxacin group (96%) compared with the ceftriaxone and/or cefuroxime axetil group (90%) (95% confidence interval [CI] of -10.7 to -1.3). Among patients with typical respiratory pathogens who were evaluable for microbiological efficacy, the overall bacteriologic eradication rates were superior for levofloxacin (98%) compared with the ceftriaxone and/or cefuroxime axetil group (85%) (95% CI of -21.6 to -4.8). Levofloxacin eradicated 100% of the most frequently reported respiratory pathogens (i.e., H. influenzae and S. pneumoniae) and provided a \textgreater98% clinical success rate in patients with atypical pathogens. Both levofloxacin and ceftriaxone-cefuroxime axetil eradicated 100% of the S. pneumoniae cells detected in blood culture. Drug-related adverse events were reported in 5.8% of patients receiving levofloxacin and in 8.5% of patients administered ceftriaxone and/or cefuroxime axetil. Gastrointestinal and central and peripheral nervous system adverse events were the most common events reported in each treatment group. In conclusion, these results demonstrate that treatment with levofloxacin is superior to ceftriaxone and/or cefuroxime axetil therapy in the management of community-acquired pneumonia in adults.
Identifier
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<a href="http://doi.org/10.1097/00019048-199802000-00005" target="_blank" rel="noreferrer noopener">10.1097/00019048-199802000-00005</a>
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*Levofloxacin
1997
80 and over
Administration
Adolescent
Adult
Aged
Anti-Infective Agents/adverse effects/*therapeutic use
Antimicrobial agents and chemotherapy
Bacterial/*drug therapy/microbiology
Ceftriaxone/adverse effects/*therapeutic use
Cefuroxime/adverse effects/*analogs & derivatives/therapeutic use
Cephalosporins/adverse effects/*therapeutic use
Combination
Community-Acquired Infections/drug therapy/microbiology
Department of Internal Medicine
Drug Therapy
Dunbar L
Female
File T M Jr
Humans
Injections
Intravenous
Kohler R
Kojak C
Male
Middle Aged
NEOMED College of Medicine
Ofloxacin/adverse effects/*therapeutic use
Oral
Player R
Pneumonia
Prodrugs/adverse effects/*therapeutic use
Prospective Studies
Rubin A
Segreti J
Treatment Outcome
Williams R R