Abstract
Our objective was to prospectively determine the factors influencing the probability of a good microbiological or clinical outcome in patients with nosocomial pneumonia treated with a fluoroquinolone. Levofloxacin was administered as an infusion of 500 mg/h for 1.5 h (total dose, 750 mg). For patients with Pseudomonas aeruginosa or methicillin-resistant Staphylococcus aureus, a second drug was added (ceftazidime or piperacillin/tazobactam for P. aeruginosa and vancomycin for methicillin-resistant S. aureus). Population pharmacokinetic studies of 58 patients demonstrated that this population handled the drug differently from populations of volunteers. Multivariate logistic regression analysis (n=47 patients) demonstrated that only the age of the patient and the achievement of an area under the curve: minimum inhibitory concentration ratio of > or =87 had a significant effect on eradication of the pathogen (P<.001). Achieving the breakpoint made the patient 4 times more likely to achieve eradication. The effect was greatest in patients > or =67 years old.
Publication types
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Clinical Trial
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Comparative Study
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Randomized Controlled Trial
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Research Support, Non-U.S. Gov't
MeSH terms
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Adult
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Aged
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Aged, 80 and over
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Anti-Infective Agents / administration & dosage
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Anti-Infective Agents / pharmacokinetics*
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Anti-Infective Agents / therapeutic use
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Area Under Curve
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Cross Infection / drug therapy
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Cross Infection / microbiology
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Female
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Fluoroquinolones / administration & dosage
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Fluoroquinolones / pharmacokinetics*
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Fluoroquinolones / therapeutic use
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Humans
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Levofloxacin*
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Male
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Methicillin Resistance
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Microbial Sensitivity Tests
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Middle Aged
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Ofloxacin / administration & dosage
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Ofloxacin / pharmacokinetics*
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Ofloxacin / therapeutic use
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Pneumonia, Bacterial / drug therapy*
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Pneumonia, Bacterial / microbiology
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Pneumonia, Staphylococcal / drug therapy
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Pneumonia, Staphylococcal / microbiology
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Pseudomonas Infections / drug therapy
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Pseudomonas Infections / microbiology
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Pseudomonas aeruginosa / drug effects*
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Staphylococcus aureus / drug effects*
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Treatment Outcome
Substances
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Anti-Infective Agents
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Fluoroquinolones
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Levofloxacin
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Ofloxacin