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The Experience of Using Levofloxacin in the Emergency Department

Sheng-Chuan Hu, MD
Professor and Chief of the Emergency Department, Tzu-Chi University and Medical Center, Hualien, Taiwan

Statistically, the percentage of antibiotic use in the emergency department (ED) is approximately 10%, especially in referral medical centers. The elderly are the largest users of antibiotics, non-trauma patients aged over 65 in the ED account for 11.9% of antibiotic use. The principles of empirical antibiotic use are based primarily on guidelines released from associations such as the Infectious Diseases Society of America, the American Thoracic Society, the British Thoracic Society, the Canadian Infectious Diseases Society, and the Canadian Thoracic Society. However, application varies according to drug resistance, which is dependent on the strain of bacteria in individual regions, and the severity of illness. In the ED, the most commonly seen infectious diseases are community-acquired pneumonia (CAP), urinary tract infection (UTI), acute exacerbations of chronic bronchitis (AECB), and acute exacerbations of chronic obstructive pulmonary disease (AECOPD) (1,2). Therapeutic guidelines have recommended ceftriaxone and levofloxacin as first line agents for treatment, although the detailed guidelines are quite complex. According to our experience at the Tzu-Chi University and Medical Center, there are certain situations where levofloxacin use in the ED is beneficial. Our indications for levofloxacin include: severe infection, shock, low blood pressure, multiple-lobe infiltration shown on a chest X-ray; aged patients or patients with cancer; patients required to stay in the observation room of the ED for further treatment due to CAP, AECB, AECOPD or UTI, who are unlikely to be admitted very soon; patients with any of the aforementioned diseases with no toxic signs (oral levofloxacin), as can those patients with poor compliance or those who live far from the hospital, which makes follow-up problematic; and patients with fever of unknown origin.

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Last updated January, 2005