Comparative Efficacy of Levofloxacin Versus Amoxycillin/Clavulanic Acid Combined with Azithromycin in Treatment of Community-Acquired Pneumonia

Abstract

Background: Community-acquired pneumonia (CAP) is an important cause of mortality and morbidity worldwide. Early initiation of antibiotics is highly recommended. In most CAP cases, multiple drug options are increasingly becoming available, but there is often a lack of evidence that allows for a direct comparison of the efficacy of one drug versus another. 

Aim: The main objective was to compare treatment outcomes using oral levofloxacin alone and combined azithromycin and amoxicillin/Clavulanic acid in outpatient treatment of Community-acquired pneumonia.

Methods: This study was a prospective longitudinal design. Patients diagnosed with CAP were randomly assigned to first and second treatment groups. Community-acquired pneumonia was diagnosed according to America Thoracic Society criteria. The sample size of 78 was arrived at by Yamane Taro (1967) formula. Every patient diagnosed and treated in the outpatient department who gave written consent to participate was enrolled in the study and randomly assigned to one of the treatment groups. Minors below 18 years were excluded from the study. Data were analysed using SPSS for Windows version 26. An independent t-test compared the effectiveness of the two treatment groups. Changes in white blood cell count during the follow-up visits were done using a chi-square test. A p-value of <0.05 was considered statistically significant.

Results. The majority, 33(50%) of the patients, were aged between 21 and 29 years, and over sixty percent, 42(63.6%) of participants were females. Of all the participants, 66(100%) had a cough and chest pain, 57(86.4%) had crackles, and about ten percent, 6(9.1%) had difficulty breathing at the time of admission into the study. About 29(43.9%) of patients had a fever at baseline, and 14(21.2%) had a respiratory rate between 16 and 29 breaths per minute at baseline. A combination of azithromycin and amoxycillin/clavulanic acid was associated with statistically significant faster resolution of chest pains and cough (mean 1.7 and 3.14 days, respectively) compared to levofloxacin group (mean 2.21 and 3.71 days, respectively) in patients who had community-acquired pneumonia (p=0.009. There was no difference in fever resolution, time to crackles subsidence, resolution of difficulty in breathing, and change in white blood cell count in participants in the two treatment groups.

Conclusions: Azithromycin combined with amoxycillin/clavulanic acid reduced chest pain in 1.70 days (SD=0.618) compared to levofloxacin alone (2.21 days, SD=1.204) (p=0.009). Azithromycin combined with amoxycillin/clavulanic acid reduced cough in 3.14 days (SD=0.789) versus levofloxacin alone (3.70 days, SD=0.588) (p=0.014). Hence, the azithromycin plus amoxycillin/clavulanic acid combination was found to be superior for managing CAP.