From the *Childrenʼs Hospital and Health Center, San Diego, CA; †Instituto de Atención Pediátrica, Neeman-ICIC, Universidad de Ciencias Médicas, San José, Costa Rica; ‡Case Western Reserve University, Rainbow Babies Hospital and Childrenʼs Hospital, Cleveland, OH; §Hospital del Niño, Ciudad de Panamá, Panamá; and ∥Johnson and Johnson Pharmaceutical Research and Development, L.L.C., Raritan, NJ.
BACKGROUND:: Levofloxacin has established efficacy and safety in the treatment of community-acquired pneumonia (CAP) in adults, and its use as an alternative therapy for children with CAP has been proposed.
OBJECTIVE:: Assess the clinical efficacy and safety of levofloxacin compared with standard of care antibiotic therapy in the treatment of CAP in children aged 6 months to 16 years.
METHODS:: In an open-label, multicenter, noninferiority trial, children with CAP were randomized 3:1 to receive levofloxacin or comparator antimicrobial therapy (0.5 to <5 years: amoxicillin/clavulanate or ceftriaxone; >/=5 years: clarithromycin or ceftriaxone with clarithromycin or erythromycin lactobinate) for 10 days. The primary outcome was cure rates at the test-of-cure visit (10-17 days after completing treatment) as determined by symptoms, physical examination, and chest radiography.
RESULTS:: Seven hundred and thirty-eight children were enrolled and 539 (405 levofloxacin-treated, 134 comparator-treated) were clinically evaluable at test-of-cure visit. Clinical cure rates were 94.3% (382 of 405) in levofloxacin-treated and 94.0% (126 of 134) in comparator-treated children. Cure rates were also similar for levofloxacin and comparator for each age group (<5 years, 92.2% versus 90.8%; >/=5 years, 96.5% versus 97.1%; respectively) and for children categorized as being at higher risk for severe disease. Mycoplasma pneumoniae was the most frequently identified cause of pneumonia (230 children). Levofloxacin was as well tolerated as comparators, with similar type and incidence of adverse events.
CONCLUSIONS:: Levofloxacin was as well tolerated and effective as standard-of-care antibiotics for the treatment of CAP in infants and children.