JAC Advance Access published online on February 11, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg115
© 2003 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Department of Microbiology, University
Hospital Lewisham, London SE13 6LH, UK
* Corresponding author. E-mail: gopal.rao{at}uhl.nhs.uk.
Received 23 August 2002
; revised 15 October 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
Keywords: levofloxacin, Clostridium difficile-associated
diarrhoea (CDAD)
Clostridium difficile-associated
diarrhoea in patients with
community-acquired lower respiratory infection being treated with levofloxacin
compared with
-lactam-based
therapy
2 Department of Medicine, University
Hospital Lewisham, London SE13 6LH, UK
-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 -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 -lactams
(-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 -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 -lactam-based therapy for LRTI.
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