[Levofloxacin in the treatment of community-acquired pneumococcal pneumonia].

OBJECTIVES: Levofloxacin is a new fluoroquinolone active against S. pneumoniae. Oral and intravenous administration is available. The aim of this study was to determine its efficacy in community-acquired pneumonia. PATIENTS AND METHODS: Five clinical trials included 1989 patients eligible for analysis. The dosage was 500 mg once or twice a day depending on the studies. Levofloxacin was compared with amoxicillin (3 g/d), amoxicillin/clavulanic acid (1500 mg/d), ceftriaxone (1-4 g/d combined or not with a macrolide and/or relay cefuroxime axetil). RESULTS: In these studies and among the patients eligible for analysis, microbiologically proven S. pneumoniae pneumonia occurred in 170 of the patients treated with levofloxacine and in 140 treated with the comparator. Bacteriemia was evidenced in 51/170 of the levofloxacin-treated patients (30%) and in 45/140 (32%) of the comparator-treated patients. At treatment end, clinical success rate was 93.5% (159/170) for levofloxacin and 90.7% (127/140) for comparators. S. pneumoniae eradication rate was comparable for levofloxacin (94.9%) and comparators (95.3%). In patients with bacteriemia, the clinical success rate was 86.2% (44/51) for levofloxacin and 84.4% (38/45) for comparators. DISCUSSION: These findings establish the efficacy of levofloxcin for the treatment of pneumococcal pneumonia, a major treatment challenge in community-acquired pneumonia. This compound has its place in the context of good use of antibiotics. Levofloxacin should be used in priority for patients with risk factors for complications with rapidly unfavorable course or as second intention treatment when re-evaluating insufficient therapeutic response.