[Therapeutic experience with levofloxacin in pneumonia and COPD]

The possible usefulness of levofloxacin in the empirical therapy of community acquired pneumonia, as monotherapy, (as alternative to the beta-lactam + macrolide combination) in once-a-day administration is supported by a body of evidence emerged from a wide world clinical documentation. Related to its possible use in sequential therapy, clinical and economic advantages are also been shown. In fact, a number of clinical experimental studies have evidenced that levofloxacin allows an earlier attainment of clinical stabilization, and resulting therapeutic switch, and is also associated with a more rapid and efficient achievement of outcomes, either early (microbiological response, time to clinical stabilization, length of stay) or late (clinical cure, radiological resolution, and mortality indexes), revealing a very favourable impact on cost-efficacy ratio. Published clinical studies concerning acute bacterial exacerbation of chronic bronchitis (ABECB) or chronic obstructive pulmonary (COPD) disease are also available, evidencing clinical and bacteriological efficacy of levofloxacin when compared to different therapeutic regimens, used at any severity grade, its use being related with a higher bacteriological eradication rate. However, caution must be observed in the use of fluoroquinolones for treatment of acute bacterial exacerbation of COPD, due to rising concern about possible bacterial resistance, especially in S. pneumonaie e P. aeruginosa, that might emerge towards this antimicrobial class, although, to date, levofloxacin appears to be only marginally affected, in terms of resistance rates and of clinical significance.