Clostridium difficile-associated diarrhoea in patients with community-acquired lower respiratory infection being treated with levofloxacin compared with beta-lactam-based therapy
Abstract
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 beta-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 beta-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 beta-lactams (beta-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 beta-lactam group…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 490 participants or records.
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