Vol.74 No.2 March 2026
A retrospective comparison of conventional antibiotic therapy versus lascufloxacin therapy in patients with lung abscesses and empyema
1)Department of Clinical Research Center, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino city, Osaka, Japan
2)Department of Pulmonary and Critical Care Medicine, Osaka Habikino Medical Center
3)Department of Thoracic surgery, Osaka Habikino Medical Center
Abstract
Background: Many patients with lung abscesses and empyema require long-term administration of broad-spectrum antibiotics, often in conjunction with surgical treatment. At our hospital, we introduced lascufloxacin (LSFX), which shows excellent lung tissue penetration and anti-anaerobic activity, but does not exhibit anti-Pseudomonas aeruginosa activity, for the treatment of patients with lung abscess/empyema. We examined the treatment details and clinical course of hospitalized patients with lung abscess/empyema treated with LSFX over a period of 16 months following its introduction at our hospital.
Subjects and Methods: Of the 73 patients with lung abscess/empyema admitted to our hospital between March 2022 and June 2023, we analyzed the data of 63 patients, after excluding 10 cases due to complication by other systemic infections or transfer/death due to underlying diseases. The patients, including 35 patients with lung abscess/medical empyema (empyema not requiring or intolerant to surgical treatment) and 28 patients with lung abscess/surgical empyema (empyema treated with surgical treatment) were classified into three antibiotic treatment groups: a narrow-spectrum antibiotic group (NSA group), a broad-spectrum antibiotic group (BSA group), and a group in which the treatment was switched from conventional antibiotics to LSFX (LSFX group). In the patients of the LSFX group, the antibiotic was changed to LSFX after failure (i.e., no improvement of the serum CRP or symptoms) of four or more days of conventional antibiotic therapy. The cure rate (negative CRP, resolution of respiratory symptoms, and stable clinical condition on day 7 after treatment cessation) and the total duration (in days) of antibiotic administration were compared among the three treatment groups in the subject population overall, and in the lung abscess/medical empyema and lung abscess/surgical empyema patients. Next, the increase in the serum albumin (Alb) levels from the lowest value, rate of recovery of the serum Alb level to baseline value and the bacteria detected at the time of starting treatment or changing medication, were examined in the three treatment groups. Furthermore, factors associated with the total duration of antibiotic administration in the subject population were examined by multivariate analysis.
Results: Complete cure was achieved in all 35 patients with lung abscess/medical empyema and 28 patients with lung abscess/surgical empyema. The mean total treatment durations in the LSFX group, NSA group, and BSA group were 22.1±5.6 days, 36.5±12.2 days, and 55.2±23.6 days, respectively, among patients with lung abscess/medical empyema (p<0.001), and 30.5±7.5 days, 39.1±10.6 days, and 44.0±11.2 days, respectively, among patients with lung abscess/surgical empyema (p<0.05). The overall recovery rate of the serum Alb levels was 93.2% (55/59), and that in the LSFX group was 93.8% (15/16). P. aeruginosa and extended-spectrum β-lactamase-producing bacteria were detected in sputum samples at the time of starting treatment or changing medication in 8 and 2 patients, respectively, with no difference in the detection rates among the three treatment groups (p=0.66). Furthermore, the factors associated with an increased duration of antibiotic therapy identified by multivariate analysis included three treatment group division (LSFX, NSA, and BSA groups, p<0.001) and low serum Alb levels at treatment initiation (p<0.05). No adverse events were observed in any of the patients.
Discussion: Our study of hospitalized patients with lung abscess/empyema suggests that the total duration of antibiotic therapy required to achieve cure may be shorter in the LSFX group as compared with the other two groups.
Key word
lung abscess, empyema, lascufloxacin, surgical treatment
Received
April 11, 2025
Accepted
December 9, 2025
Jpn. J. Chemother. 74 (2): 170-178, 2026
