Vol.56 No.1 January 2008
Efficacy of levofloxacin (600 mg per day) for moderately severe community-acquired pneumonia
1)Respiratory Medicine, Hiroshima Prefectural Hospital, 1-5-54, Ujinakanda, Minami-ku, Hiroshima, Japan
2)Department of Clinical Research, Hara-doi Hospital
3)Respiratory Medicine, Kawasaki Hospital
Abstract
In the present study conducted during actual clinical use, we obtained data on the administration of levofloxacin(LVFX) at the maximum dose approved in Japan, which is 600 mg/day (200 mg tds), to patients with moderately severe community-acquired pneumonia. Both LVFX monotherapy and LVFX combined with initial short-term parenteral therapy (for a maximum of 3 days) with other antibiotics were evaluated for clinical efficacy and safety.
Among the patients included in the evaluation of clinical efficacy, the efficacy rate of LVFX was 90.3% (84/93). LVFX monotherapy was given to 55 patients (59.1%), combined therapy was administered to 28 patients (30.1%), and therapy switching was conducted in 10 patients (10.8%). The efficacy rates of these three regimens were 90.9%, 89.3%, and 90.0%, respectively.
Causative organisms were isolated in 51.6% (33/64) of the patients, with the most common being Streptococcus pneumoniae (20.3%), Haemophilus influenzae (17.2%), and Moraxella catarrhalis (4.7%). The microbiological efficacy rate was 100% (13/13) in the LVFX monotherapy group, 91.7% (11/12) in the combined therapy group, and 100% (1/1) in the therapy switching group. With respect to atypical pathogens, Legionella pneumophila was not detected, whereas Mycoplasma pneumoniae and Chlamydia pneumoniae were detected by antibody assays in 6.8% (3/44) and 16.7% (6/36) of the patients, respectively. The LVFX therapy was classified as "effective" in all 9 patients with M. pneumoniae or C. pneumoniae infection.
Adverse drug reactions occurred in 10.0% (12/120) of the patients, with 9 showing only mild reactions. Treatment with LVFX could be continued in all of these patients. Three patients had moderate adverse drug reactions that resolved rapidly after completion of LVFX administration. Over half of the patients included in the study were elderly, but no specific safety problems were observed among the elderly subjects during administration of levofloxacin at 600 mg/day in divided doses.
Based on the above results, LVFX monotherapy at 600 mg/day (200 mg tds) and LVFX combined with initial short-term parenteral therapy (≤3 days) are considered to be useful regimens for the treatment of moderately severe community-acquired pneumonia. These regimens are expected to allow ambulatory treatment at an early stage and to be more efficient in terms of medical costs.
Key word
levofloxacin, community-acquired pneumonia, efficacy, safety
Received
July 2, 2007
Accepted
October 11, 2007
Jpn. J. Chemother. 56 (1): 21-32, 2008
