Community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality in the elderly. Nonetheless, little is known about the impact of specific antibiotic regimens on outcomes in this cohort.
We conducted a subgroup analysis of elderly patients (defined as age > 65 years) from a multicenter, double-blind study of CAP. In this trial, patients were randomized to treatment with either levofloxacin (L) 750 mg daily for 5 days or to L 500mg daily for 10 days. Clinical success (cure or improvement) served as the primary endpoint. Mortality assessed between days 28–31 and microbiologic eradication rates represented secondary endpoints. We also extracted data regarding safety and adverse events.
The original trial included 528 patients (both outpatients and inpatients) of which 172 (32.6%) were 65 years or older. The most frequently isolated pathogens were M. pneumoniae (n=19), S. pneumoniae (n=16), and H. influenzae (n=13). Individuals receiving the 750mg regimen were slightly younger than those treated with 500mg (73.1 years vs. 75.0 years, p=0.03) but were otherwise comparable (% male: 53.8% vs. 57.6%, p=NS; median Pneumonia Severity Index class: III in both groups). Outcomes are shown in the table.
750mg500mgPClinical Success: Clinically Evaluable Patients88.5%92.2%0.49Micro-Eradication: Microbiologically Evaluable Patients90.3%87.5%0.77Mortality5.0%4.4%0.86Both regimens were well tolerated in the elderly with few serious adverse events: 11.3% for 750 mg vs. 16.7% for 500mg (p=0.31).
In this subgroup analysis of elderly patients with CAP, treatment with 750mg L for five days performed as well as 500mg for 10 days. Both regimens were well tolerated.
Levofloxacin 750mg daily for 5 days is a safe and effective alternative for CAP in the elderly.
A.F. Shorr, OMP