The Role of 750 mg Once-Daily Levofloxacin in the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Diseases

29 March, 2018

Question 10

What was the bacterial eradication like with levofloxacin and how did this compare to the results found with amoxicillin-clavulanate or other comparator agents?

Among the complicated bronchitis patients, the microbiological eradication rate was 81.4% after 5 days of levofloxacin compared to 79.8% after 10 days of amoxicillin/clavulanate (Table 2) (7).

Table 2. Microbiological eradicationa rates at the post-therapy visit in microbiologically evaluable population

   Uncomplicated group
Complicated group
Levofloxacin Azithromycin 95% CIb Levofloxacin Amoxicillin/
clavulanate
95% CIb
Pathogen category
   Gram-positive aerobic pathogens 20/22 (90.9) 12/15 (80.0) -37.8-16.0 21/24 (87.5) 14/19 (73.7) -40.3-12.6
   Gram-negative aerobic pathogens 76/81 (93.8) 88/105 (83.8) -19.4-0.6 75/93 (80.6) 88/106 (83.0) -8.9-13.7
Total by pathogen 96/103 (93.2) 100/120 (83.3) -18.6-1.1 96/117 (82.1) 102/125 (81.6) -10.6-9.7
Total by patientc 75/80 (93.8) 72/87 (82.8) -21.2-0.8 70/86 (81.4) 71/89 (79.8) -13.9-10.7
Pathogen
   Enterobacter cloacae 1/1 (100.0) 3/5 (60.0)    0/0 (0.0) 0/0 (0.0)   
   Haemophilius influenzae 26/27 (96.3) 21/24 (87.5) -25.9-8.3 25/30d (83.3) 20/20 (100.0) 0.8-32.5
   Haemophilius parainfluenzae 18/20 (90.0) 20/23 (87.0) -24.6-18.5 18/20 (90.0) 15/18 (83.3) -31.1-17.8
   Klebsiella pneumoniae 2/2 (100.0) 5/6 (83.3)    1/2 (50.0) 4/5 (80.0)   
   Moraxella catarrhalis 14/14 (100.0) 18/20 (90.0) -26.7-6.7 10/12 (83.3) 16/19 (84.2) -30.0-17.8
   Pseudomonas aeruginosa 3/3 (100.0) 4/6 (66.7)    3/5 (60.0) 4/5 (80.0)   
   Staphylococcus aureus 7/7 (100.0) 0/2 (0.0)    4/5 (80.0) 3/5 (60.0)   
   Streptococcus pneumoniae 11/12 (91.7) 10/11 (90.9) -28.4-26.9 16/18 (88.9) 10/13 (76.9) -42.9-19.0
Data are presented as n/N patients, unless otherwise stated.
a  Eradication plus presumed eradication.
b  Two-sided 95% CI around the difference of comparator minus levofloxacin.
c  Eradication of all pathogens identified at study entry for a patient.
d  One patient was inappropriately assessed as a failure by the investigator, even though all of the patient’s baseline symptoms were resolved and H. influenzae had been eradicated.
Abbreviation: CI = confidence interval.
Adapted from reference (7).