Addition of levofloxacin to standard treatment for staphylococcal bacteremia: results of a prospective randomized trial

The objective of a prospective, randomized, multicenter study by E. Ruotsalainen et al. (Finland) for the period January 2000 to August 2002, it has been determined whether the addition of levofloxacin to standard treatment leads to a decrease in mortality and in the incidence of complications of bacteremia caused by Staphylococcus aureus .

The study included 381 patients with bacteriemia caused by S. aureus, with the exception of patients with meningitis, as well as those in whom strains resistant to the fluoroquinolones and methicillin of the pathogen been isolated. Patients received standard treatment (mainly semi-synthetic penicillins) (n = 190) or standard treatment with levofloxacin (n = 191). If a deep infectious process is suspected, additional rifampicin has been recommended. Mortality at day 28 and after 3 months, as well as the clinical and biological parameters of the patients were used as evaluation criteria.

According to the results, the addition of levofloxacin to standard treatment was not accompanied by a significant reduction in mortality: 14% in both groups on day 28 of treatment and 21% in patients receiving standard treatment, against 18% in patients receiving levofloxacin after 3 months. The frequency of complications, the timing of normalization of body temperature, a decrease in the concentration of reactive protein C, as well as the duration of antibiotic therapy did not differ significantly in the two groups.

Deep infection was detected in 84% of patients within one week of randomization with the same frequency in both groups. Note a higher frequency of detection of deep infections during the study compared to published data. After 3 months, the death rate in patients with deep infections was 17% in patients receiving rifampicin, compared to 38% not receiving (odds ratio 3.06, 95% confidence interval 1.69 -5.54; P minus 0.001).

Thus, the addition of levofloxacin to standard treatment did not significantly affect the outcome of the disease, the incidence of deep infections and the recovery rate in patients with bacteremia caused by S. aureus.