Comparison of the Efficacy of Adding Inhaled Levofloxacin and Colistin to a Basic Regimen of Colistin and Meropenem in the Treatment of Ventilator-associated Pneumonia Caused by Multidrug-resistant Gram-negative Bacteria: A Randomized Open-label Clinical Trial
Abstract
Objective: Ventilator-associated pneumonia (VAP) caused by multidrug-resistant Gram-negative bacteria (MDR-GNB) is a major intensive care unit challenge, particularly in Iran, due to limited antibiotic options. This study compared the efficacy of adding levofloxacin and colistin inhalation form to the baseline regimen of colistin and meropenem in treating VAP caused by MDR-GNB. Methods: Patients with VAP were randomly assigned to the colistin group ( n = 24), receiving 2 million international unit (MIU) every 8 h, and the levofloxacin group ( n = 22), receiving 250 mg every 12 h, alongside intravenous colistin (4.5 MIU every 12 h) and meropenem (1 g every 8 h). Clinical improvement using the Clinical Pulmonary Infection Score (CPIS) on days 1, 5, and 7, the clinical response on day 7, and inflammatory markers (erythrocyte sedimentation rate and C-reactive protein) on days 1, 3, 5, and 7 were evaluated. Findings: CPIS scores significantly decreased in both groups: Colistin (−3.67 ± 2.14, P 0.05). Acute kidney injury occurred only in the colistin group ( n = 8; 33.3%). Bronchospasm and cough occurred in one levofloxacin patient (4.54%), showing a significant difference in adverse effects ( P = 0.004). Mortality rates were higher in the colistin group ( n = 17; 70.8%) compared to the levofloxacin group ( n = 10; 45.5%), though this difference was not statistically significant ( P = 0.08). Conclusion: Levofloxacin inhalation may be considered an effective alternative to colistin…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 24 participants or records.
Read the paper
Related studies
- Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching
- Thiophenes—Naturally Occurring Plant Metabolites: Biological Activities and In Silico Evaluation of Their Potential as Cathepsin D Inhibitors
- Inhalable Mannosylated Rifampicin–Curcumin Co-Loaded Nanomicelles with Enhanced In Vitro Antimicrobial Efficacy for an Optimized Pulmonary Tuberculosis Therapy
- Association between cord blood 25-hydroxyvitamin D concentrations and respiratory tract infections in the first 6 months of age in a Korean population: a birth cohort study (COCOA)
- GC-MS Analysis and Biomedical Therapy of Oil from n-Hexane Fraction of Scutellaria edelbergii Rech. f.: In Vitro, In Vivo, and In Silico Approach
- Novel Pharmacokinetic/Pharmacodynamic Parameters Quantify the Exposure–Effect Relationship of Levofloxacin against Fluoroquinolone-Resistant Escherichia coli
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.