Clinical implications of 750mg, 5-day levofloxacin for the treatment of community acquired pneumonia

Objective: To evaluate the time to symptom resolution and IV-to-PO transition in community-acquired pneumonia (CAP) patients treated with 750 mg or 500 mg levofloxacin. Research Design: A retrospective, subset analysis of a multicenter, randomized, double-blind, controlled trial comparing 750mg levofloxacin for 5 days to 500 mg levofloxacin for 10 days for the treatment of CAP. Patients and Methods: A total of 528 CAP patients were included. Baseline symptoms were re-evaluated on Day 3 of therapy, and time to IV-to-PO transition was recorded for inpatients. Results: For the overall population, 67.4% of patients receiving 750 mg levofloxacin had resolution of fever by Day 3 of therapy, compared to 54.6% of 500 mg treated patients (P = 0.006). Patients who started on 750 mg levofloxacin IV (N = 108) transitioned to PO in an average of 2.68 days while those starting on 500 mg IV (N = 124) transitioned in 2.95 days (P = 0.144). The median time for IV-to-PO switch was 2.35 days and 2.75 days for patients receiving 750 mg and 500 mg levofloxacin, respectively (P= 0.098, log rank test). By Day 3 of therapy, 68% of patients receiving the 750 mg dose had transitioned from IV to PO levofloxacin, compared with 61% of the 500 mg group (P = 0.280). The safety profiles were comparable for the two regimens. Conclusions: The 750mg levofloxacin dose resulted in a greater proportion of patients with resolution of CAP symptoms by Day 3 when compared with 500 mg therapy. Consequently, the 750 mg regimen trended toward more rapid transition to PO, potentially resulting in lower overall drug costs. Time to switch from IV to PO was determined by the investigators' discretion rather than a set protocol. Additionally, length of stay data was not collected in this study, which can significantly impact overall healthcare costs. Further research is required to fully understand the economic impact of the 750 mg, 5-day levofloxacin regimen.