Treatment of community-acquired pneumonia by levofloxacin: 500 mg once daily or 500 mg twice daily?

Levofloxacin: A new anti-pneumococcal fluoroquinolone, levofloxacin, has re ceived approval in France for the treatment of community-acquired pneumonia at the dose of 500 mg once or twice a day, depending on the severity of th e disease, the germ susceptibility and the patient's weight Levofloxacin ha s a powerful and rapid bactericidal activity particularly against pneumococ ci, whatever the level of penicillin resistance. The pharmacokinetic proper ties of the compound allow once daily dosage. Pharmacodynamically, it has b een clinically demonstrated that the most predictive parameter of efficacy is the Cmax/MiC ratio. Pneumococcal pneumonia: Because of the potential gravity of pneumococcal pn eumonia, it might be preferrable to use levofloxacin at the dose of 500 mg twice daily. The efficacy of the two levofloxacin doses for the treatment o f pneumococcal pneumonia was thus analyzed. Five clinical studies including 4 comparative trials, enrolling nearly 2,000 patients with community-acqui red pneumonia were reported in the international approval document Among th ese patients, 310 had documented pneumococcal pneumonia including 31% with bacteriemia. Task Force Report: On the basis of available data, the level of proof is su fficient to prescribe levofloxacin at the dose of 500 mg once daily for the treatment of mild to moderately severe community-acquired pneumonia in amb ulatory patients, including those with suspected pneumococcal pneumonia, wi th or without baberiemia, it would be reasonable to propose the 500 mg twic e daily dosage for severe community-acquired pneumonia warranting intensive care hospitalization in accordance with the criteria of the ERS Task Force Report. The well-founded rationale of this therapeutic strategy should be validated by the results of ongoing studies and by following the evolution of germ susceptibility to these new compounds.