JAC Advance Access originally published online on February 11, 2003
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Journal of Antimicrobial Chemotherapy (2003) 51, 697-701
© 2003 The British Society for Antimicrobial Chemotherapy
Clostridium difficile-associated diarrhoea in patients with community-acquired lower respiratory infection being treated with levofloxacin compared with ß-lactam-based therapy
Departments of 1 Microbiology and 2 Medicine, University Hospital Lewisham, London SE13 6LH, UK
Received 23 August 2002; returned 15 October 2002; revised 28 November 2002; accepted 4 December 2002
The aim of the study was to compare the incidence of Clostridium difficile-associated diarrhoea (CDAD) following treatment of community-acquired lower respiratory tract infection (LRTI) in hospitalized patients with levofloxacin or a ß-lactam-based therapy. Nine hundred and thirty-eight patients were included in the prospective open-labelled ‘randomized’ trial. This included 490 patients treated with levofloxacin and 448 patients treated with ß-lactams such as cefuroxime or amoxicillin. The overall incidence of CDAD was 3.8%. There was a lower incidence of CDAD (P < 0.01) in the patients treated with levofloxacin (levofloxacin group) (11/490; 2.2%) compared with patients treated with ß-lactams (ß-lactam group) (25/448; 5.6%), particularly with cefuroxime (cefuroxime group) (21/229; 9.2%; P < 0.0001). There was no significant difference (P = 0.6) in the incidence of CDAD between patients treated with levofloxacin or amoxicillin (amoxicillin group) (4/219; 1.8%). Patients in the cefuroxime and amoxicillin groups had a significantly longer duration of treatment than patients in the levofloxacin group. Although previous antibiotic therapy was a significant risk factor for CDAD in each of the groups, previous antibiotic therapy or admission to specific wards in the hospital were not confounding factors when comparing the groups. The levofloxacin group had a significantly shorter duration of hospitalization (mean 11.7 days; P < 0.01) compared with the ß-lactam group (mean 13.3 days), especially compared with the cefuroxime group (mean 16 days; P < 0.0000001). The amoxicillin group (mean 10.5 days) had a shorter duration of stay compared with the levofloxacin group, but this was not found to be statistically significant. Patients with CDAD had a longer duration of hospital stay than those without CDAD (CDAD +ve 25.8 days; CDAD –ve 11.9 days; P < 0.0000001). In conclusion, levofloxacin is less likely to be the cause of CDAD and is associated with a shorter duration of hospital stay compared with ß-lactam-based therapy for LRTI.
Keywords: levofloxacin, Clostridium difficile-associated diarrhoea (CDAD)
* Corresponding author. E-mail: gopal.rao{at}uhl.nhs.uk
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