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MINERVA PNEUMOLOGICA

A Journal on Diseases of the Respiratory System


Official Journal of the Italian Society of Thoracic Endoscopy
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Minerva Pneumologica 2004 December;43(4):183-8

Intravenous (iv) azithromycin (AZM)/ ceftriaxone followed by po AZM versus iv lefofloxacin (LEV) followed by po LEV in treatment of hospitalized patients with community-acquired pneumonia

Zervos M., Andrews C., Amsden G., Knirsch C., Swanson R., De Caprariis P., Mandell L.


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Aim. Treatment options for hospitalized community-acquired pneumonia (CAP) patients include a ß-lactam/macrolide combination or monotherapy with an antipneumococcal fluoroquinolone. We compared clinical efficacy/safety of sequential therapy with intravenous (IV) azithromycin (AZM; 500 mg qd)/ceftriazone (CEF; 1 g qd) followed by PO AZM (500 mg qd) versus IV levofloxacin (LEV 500 mg qd) followed by PO LEV (500 mg qd) in patients with moderate/severe CAP.
Methods. This was a randomized, multicenter, open-label study. Length of therapy: AZM/CEF was 7 to 10 days and LEV 7 to 14 days. Clinical and bacteriological outcomes were assessed on Day 12-16, end of treatment (EOT), and on Day 28-35, end of study (EOS).
Results. One hundred ten and 102 patients were treated with AZM/CEF and LEV, respectively. Hospital length of stay was 8.3 days versus 8.6 days, respectively. Majority of patients were in risk classes III/IV (Fine Pneumonia Severity Index); mean risk index was similar (97.7 for AZM/CEF; 97.8 for LEV). Mean age was 70.7 years in AZM/CEF group and 72.8 years in LEV group. In the clinically evaluable analysis, clinical success rates (cure or improvement) at EOT were 91.5% for AZM/CEF and 89.3% for LEV. EOS success rates (cure only) were 89.2% for AZM/CEF versus 85.1% for LEV (95% CI: ­6.7%, 14.8%). Response rates for the most frequently isolated pathogens were similar in both groups. Incidence of treatment related adverse events was comparable.
Conclusion. Intravenous AZM/CEF followed by PO AZM was comparable in efficacy and safety to IV LEV followed by PO LEV in treating hospitalized patients with CAP.

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