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High-Dose Levofloxacin for the Treatment of Community-Acquired Pneumonia

Andrew F. Shorr, MD, MPH, FCCP
Department of Medicine Pulmonary and Critical Care Medicine,
Washington Hospital Center, Washington, DC, USA

A retrospective subgroup analysis of an earlier study compared 750 mg 5-day levofloxacin with a 500 mg 10-day course in patients with Pneumonia Severity
Index (PSI) Class III/IV community-acquired pneumonia (CAP). The initial study confirmed that the 750 mg shorter duration regimen was as effective and as well tolerated as the usual 500 mg longer duration course in patients with mild-moderate disease. Results from the subgroup analysis revealed that the higher dose therapy was also as effective and safe in patients with more severe disease. 528 patients were in the original study, with 219 classified as PSI Class III/IV. 101 patients received the 750 mg 5-day treatment, while 118 received the 500 mg 10-day course. 90.8% of the patients receiving 750 mg 5-day therapy achieved a clinical success compared with 85.5% for the 500 mg 10-day group (95% confidence interval [CI]: -5.9 to 5.4). It was also reported that the 750 mg dose was associated with a more rapid resolution of fever and purulent sputum by day 3 of therapy. Microbiological evaluation revealed that eradication rates associated with the higher dose regimen were similar to those achieved by the lower dose therapy (88.9% vs. 87.5%, respectively; 95% CI: -18.3 to 15.6). Safety assessment demonstrated both regimens to be equally well tolerated with comparable safety profiles.

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