C Garcia-Vidal1, I Sanchez-Rodriguez2, A F Simonetti3, J Burgos2, D Viasus4, M T Martin2, V Falco2, J Carratalà5. 1. Hospital Universitari de Bellvitge, IDIBELL (Institut D'investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain; REIPI (Spanish Network for the Research in Infectious Diseases), Instituto de Salud Carlos III, Madrid, Spain. Electronic address: carolgv75@hotmail.com. 2. Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. 3. Hospital Universitari de Bellvitge, IDIBELL (Institut D'investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain. 4. Hospital Universitari de Bellvitge, IDIBELL (Institut D'investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain; Health Science Division, Universidad del Norte and Hospital Universidad del Norte, Barranquilla, Colombia. 5. Hospital Universitari de Bellvitge, IDIBELL (Institut D'investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain; REIPI (Spanish Network for the Research in Infectious Diseases), Instituto de Salud Carlos III, Madrid, Spain.
Abstract
OBJECTIVES: Concerns have arisen regarding the equivalence of levofloxacin and some macrolides for treating community-acquired legionella pneumonia (LP). We aimed to compare the outcomes of current patients with LP treated with levofloxacin, azithromycin and clarithromycin. METHODS: Observational retrospective multicentre study of consecutive patients with LP requiring hospitalization (2000-2014) conducted in two hospitals. The primary outcome assessed was 30-day mortality. To control for confounding, therapy was assessed by multivariate analysis. RESULTS: We documented 446 patients with LP, of which 175 were treated with levofloxacin, 177 with azithromycin and 58 with clarithromycin. No significant differences in time to defervescence (2 (interquartile range (IQR) 1-4) versus 2 (IQR 1-3) days; p 0.453), time to achieve clinical stability (3 (2-5) versus 3 (2-5) days; p 0.486), length of intravenous therapy (3 (2-5.25) versus 4 (3-6) days; p 0.058) and length of hospital stay (7 (5-10) versus 6 (5-9) days; p 0.088) were found between patients treated with levofloxacin and those treated with azithromycin. Patients treated with clarithromycin had longer intravenous antibiotic treatment (3 (2-5.25) versus 5 (3-6.25) days; p 0.002) and longer hospital stay (7 (5-10) versus 9 (7-14) days; p 0.043) compared with those treated with levofloxacin. The overall mortality was 4.3% (19 patients). Neither univariate nor multivariate analysis showed a significant association of levofloxacin versus azithromycin on mortality (4 (2.3%) versus 9 (5.1%) deaths; p 0.164). The results did not change after incorporation of the propensity score into the models. CONCLUSIONS: In our study, no significant differences in most outcomes were found between patients treated with levofloxacin and those treated with azithromycin. Due to the small number of deaths, results regarding mortality should be interpreted with caution.
OBJECTIVES: Concerns have arisen regarding the equivalence of levofloxacin and some macrolides for treating community-acquired legionella pneumonia (LP). We aimed to compare the outcomes of current patients with LP treated with levofloxacin, azithromycin and clarithromycin. METHODS: Observational retrospective multicentre study of consecutive patients with LP requiring hospitalization (2000-2014) conducted in two hospitals. The primary outcome assessed was 30-day mortality. To control for confounding, therapy was assessed by multivariate analysis. RESULTS: We documented 446 patients with LP, of which 175 were treated with levofloxacin, 177 with azithromycin and 58 with clarithromycin. No significant differences in time to defervescence (2 (interquartile range (IQR) 1-4) versus 2 (IQR 1-3) days; p 0.453), time to achieve clinical stability (3 (2-5) versus 3 (2-5) days; p 0.486), length of intravenous therapy (3 (2-5.25) versus 4 (3-6) days; p 0.058) and length of hospital stay (7 (5-10) versus 6 (5-9) days; p 0.088) were found between patients treated with levofloxacin and those treated with azithromycin. Patients treated with clarithromycin had longer intravenous antibiotic treatment (3 (2-5.25) versus 5 (3-6.25) days; p 0.002) and longer hospital stay (7 (5-10) versus 9 (7-14) days; p 0.043) compared with those treated with levofloxacin. The overall mortality was 4.3% (19 patients). Neither univariate nor multivariate analysis showed a significant association of levofloxacin versus azithromycin on mortality (4 (2.3%) versus 9 (5.1%) deaths; p 0.164). The results did not change after incorporation of the propensity score into the models. CONCLUSIONS: In our study, no significant differences in most outcomes were found between patients treated with levofloxacin and those treated with azithromycin. Due to the small number of deaths, results regarding mortality should be interpreted with caution.
Authors: Rhoikos Furtwängler; Uwe Schlotthauer; Barbara Gärtner; Norbert Graf; Arne Simon Journal: Int J Hyg Environ Health Date: 2017-05-13 Impact factor: 5.840
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Authors: Holger Flick; Britt-Madelaine Arns; Josef Bolitschek; Brigitte Bucher; Katharina Cima; Elisabeth Gingrich; Sabin Handzhiev; Maximilian Hochmair; Fritz Horak; Marco Idzko; Peter Jaksch; Gabor Kovacs; Roland Kropfmüller; Bernd Lamprecht; Judith Löffler-Ragg; Michael Meilinger; Horst Olschewski; Andreas Pfleger; Bernhard Puchner; Christoph Puelacher; Christian Prior; Patricia Rodriguez; Helmut Salzer; Peter Schenk; Otmar Schindler; Ingrid Stelzmüller; Volker Strenger; Helmut Täubl; Matthias Urban; Marlies Wagner; Franz Wimberger; Angela Zacharasiewicz; Ralf Harun Zwick; Ernst Eber Journal: Wien Klin Wochenschr Date: 2020-07 Impact factor: 1.704
Authors: H Flick; B M Arns; J Bolitschek; B Bucher; K Cima; E Gingrich; S Handzhiev; M Hochmair; F Horak; M Idzko; P Jaksch; G Kovacs; R Kropfmüller; B Lamprecht; J Löffler-Ragg; M Meilinger; H Olschewski; A Pfleger; B Puchner; C Puelacher; C Prior; P Rodriguez; H Salzer; P Schenk; O Schindler; I Stelzmüller; V Strenger; H Täubl; M Urban; M Wagner; F Wimberger; A Zacharasiewicz; R H Zwick; E Eber Journal: Wien Klin Mag Date: 2020-05-18