Optimal Management of RTI – Intriguing New Results in ABECOPD in Asia

29 March, 2018

Question 4

There now seems to be mounting evidence supporting a shorter duration of therapy, with levofloxacin in particular being promoted as a high-dose, short-course regimen. Could you comment on the rationale behind the development of this schedule?

A high-dose, short-course levofloxacin regimen was advocated in RTI after physicians noted that many patients reported feeling better half way through a 10-day course. This lead to clinical trials investigating a shorter regimen compared with the usual 10-day schedules (6-9). Results from these trials have demonstrated that the 5-day levofloxacin regimen is as effective as the traditional 10-day course, even in patients with more severe disease (Table 1). Researchers were also interested in developing regimens that were less likely to result in resistance. Therefore, there was interest in not only looking at shorter-course therapy but also higher doses to ensure a high bacterial kill – supporting the old adage that a dead pathogen cannot become resistant. Further support for the high-dose levofloxacin regimen came from trial results demonstrating that the 750 mg dose of levofloxacin was well tolerated with a similar side-effect profile to the standard 500 mg dose (6). Clinical investigation of this regimen in community-acquired pneumonia (CAP) has shown that a levofloxacin 750 mg 5-day regimen was as effective as the 10-day schedule, and was associated with faster resolution of some symptoms (7, 10).

Table 1. Clinical success rates (%) associated with high-dose, short-course levofloxacin 750 mg for 5 days vs. 500 mg for 10 days for community-acquired pneumonia

Subjects 750 mg 5-day regimen 500 mg 10-day regimen
All patients 92.4 91.1
PSI Class I/II 93.4 96.2
PSI Class III/IV 90.8 84.9
Streptococcus pneumoniae 90.9 90.0
Haemophilus influenzae 92.3 92.9
Legionella spp. 100 100
Abbreviation: PSI = pneumonia severity index.
Adapted from reference (6).