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Early Switch Therapy from Intravenous to Oral Levofloxacin Versus Intravenous Ceftriaxone to Oral Cefuroxime Axetil in the Treatment of Moderate to Severe Community-Acquired Pneumonia

Hadiarto Manggunnegoro, MD, Wahyuningsih Soeharno, MD, Adria Rusli, MD
Department of Respiratory Medicine, Faculty of Medicine, University of Indonesia Persahabatan Hospital, Jakarta, Indonesia

The optimal duration of early switch therapy was determined in a study which investigated intravenous (IV) to oral levofloxacin compared to IV ceftriaxone to oral cefuroxime axetil in the treatment of community-acquired pneumonia (CAP). The study was a prospective, randomized, open label comparative study in which CAP patients admitted to a tertiary hospital for lung diseases were randomly assigned to one of two groups: levofloxacin 500 mg o.d. (IV or orally) for 10 days, and IV ceftriaxone 2 g o.d. followed by oral cefuroxime axetil 500 mg b.i.d. for 10 days. A total of 95 patients were enrolled in the study. The clinical success rate was 89% in the levofloxacin group compared to 79% in the ceftriaxone/cefuroxime axetil group (p = 0.173). The mean duration of IV therapy was 2.4 days for levofloxacin vs. 3.05 days (p = 0.000) for ceftriaxone. Mean length of hospital stay was 4.09 days and 4.55 days, respectively. Clinical cure rate at 1-3 days and post-therapy was 81% and 62%, respectively. Bacteriologic eradication rates were 85% for levofloxacin and 82% for ceftriaxone/cefuroxime axetil. Gastrointestinal symptoms were the most common adverse event reported in each group. These results demonstrated that in hospitalized patients with moderate to severe CAP, early switch therapy from IV to oral was successfully carried out in 89% of the levofloxacin patients, and was as effective as ceftriaxone/cefuroxime axetil. In terms of IV duration, length of stay and cost, the levofloxacin group was better and cheaper than the comparator group.

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