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                <text>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</text>
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                <text>activity; antibacterial; antibiotics; chlamydia-pneumoniae; ciprofloxacin; dr-3355; invitro activities; Microbiology; optically-active ofloxacin; Pharmacology &amp; Pharmacy; respiratory-tract infections; therapy</text>
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                <text>Tan J S; Wishnow R M; Talan D A; Duncanson F P; Norden C W; Hanna C; Christou N; Bernstein J; Marsh P; Smith M; Sapico F; Murray G; Crockersmith L L; Segreti J; Gentry L; Cullison J; Sathe S; Low I; Lamothe F; Mersey J; Dall L; Laverdiere M; Mitchell J</text>
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                <text>We compared the efficacy and safety of two beta-lactam-beta-lactamase inhibitor combinations, namely, piperacillin-tazobactam and ticarcillin-clavulanate, in the treatment of complicated bacterial infections of skin that required hospitalization. The study was a randomized, double-blind, comparative trial involving 20 centers. The infections were classified as (i) cellulitis with drainage, (ii) cutaneous abscess, (iii) diabetic or ischemic foot infection, and (iv) infected wounds and ulcers with drainage. The clinical response rates were comparable for the two treatment regimens (61% of the patients were cured with piperacillin-tazobactam and ticarcillin-clavulanate and improvement was seen in 15 and 16% of patients treated with piperacillin-tazobactam and ticarcillin-clavulanate, respectively). Both regimens were found to be safe and well tolerated. These data support the use of piperacillin-tazobactam for initial empiric therapy of hospitalized patients with complicated skin and skin structure infections.</text>
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                <text>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.</text>
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                <text>*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 &amp; 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</text>
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                <text>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.</text>
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