Intravenous (IV) azithromycin (AZM)/ceftriaxone followed by PO AZM versus IV lefofloxacin (LEV) followed by PO LEV in treatment of hospitalized patients with community-acquired pneumonia

Aim. Treatment options for hospitalized community-acquired pneumonia (CAP) patients include a β-lactam/macrolide combination or monotherapy with an antipneumococcal fluoroquinolone. We compared clinical efficacy/safety of sequential therapy with intravenous (IV) azithromycin (AZM; 500 mg qd)/ceftriazone (CEF; 1 g qd) followed by PO AZM (500 mg qd) versus IV levofloxacin (LEV 500 mg qd) followed by PO LEV (500 mg qd) in patients with moderate/severe CAP. Methods. This was a randomized, multicenter, open-label study. Length of therapy: AZM/CEF was 7 to 10 days and LEV 7 to 14 days. Clinical and bacteriological outcomes were assessed on Day 12-16, end of treatment (EOT), and on Day 28-35, end of study (EOS). Results. One hundred ten and 102 patients were treated with AZM/CEF and LEV, respectively. Hospital length of stay was 8.3 days versus 8.6 days, respectively. Majority of patients were in risk classes III/IV (Fine Pneumonia Severity Index); mean risk index was similar (97.7 for AZM/CEF; 97.8 for LEV). Mean age was 70.7 years in AZM/CEF group and 72.8 years in LEV group. In the clinically evaluable analysis, clinical success rates (cure or improvement) at EOT were 91-5% for AZM/CEF and 893% for LEV. EOS success rates (cure only) were 89.2% for AZM/CEF versus 85.1% for LEV (95% CI:-6.7%, 14.8%). Response rates for the most frequently isolated pathogens were similar in both groups. Incidence of treatment related adverse events was comparable. Conclusion. Intravenous AZM/CEF followed by PO AZM was comparable in efficacy and safety to IV LEV followed by PO LEV in treating hospitalized patients with CAP.