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Levofloxacin for the Management of Patients with Community-Acquired Pneumonia: A Comparison of Bed Days per Patient Managed with Conventional Regimens

Thomas J. Marrie, MD
Department of Medicine, University of Alberta, Edmonton, AB, Canada

We carried out a clinical trial of a critical pathway for the treatment of community-acquired pneumonia (CAP). Nine hospitals were randomized to the critical pathway (consisting of an admission guideline, treatment with levofloxacin, a guideline for switch from intravenous (IV) to oral (PO) therapy and a discharge guideline) and 10 were randomized to conventional management. A total of 1,743 patients were enrolled in the study. Pathway use was associated with a reduction in the number of bed days per patient managed from 6.1 to 4.4, a difference of 1.7 days (p = 0.04), and an 18% decrease in the admission of low-risk patients (p = 0.01). In addition, the pathway resulted in cost savings from all perspectives examined -- health care system, government and societal. These savings ranged from $457 from the health care perspective to $994 from the government perspective. Importantly, outcomes such as quality of life (QOL), mortality, admission to intensive care and complications did not differ between the two groups. We conclude that a critical pathway for the treatment of CAP results in considerable cost savings without any detrimental effects to patient welfare.

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