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Levofloxacin in the treatment of nosocomial pulmonary complications after lung resection for cancer

Abstract number: 903_r2058

Lequaglie C.

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A 2-year multicentre study is reported on 38 complicated patients with tested lung infection and resected pulmonary for cancer after antibiotic prophylaxis with cephalosporin. Twenty-seven cases had chronic bronchopulmonary disease and bronchial asthma in four. Thirty-two lobectomies and six pneumonectomies were performed. The microbiological diagnosis of infection was achieved in the majority of the cases by bronchoalveolar lavage. The isolated pathogens were Haemophilus influenzae (15), Streptococcus pneumoniae (11), Moraxella catarrhalis (3), Mycoplasma pneumoniae (7), Chlamydia pneumoniae (1) and Legionella pneumophila (1).

A quinolone, Levofloxacin, was administered at the dosage of 500 mg i.v. twice day for 10 days. Cough was the most frequent observed symptom (35/38 cases) between the third and the 10th day of therapy; thoracic pain was present in 32/38 cases between the third and the 10th day; dyspnoea was in 29/38 cases between the second and the 10th day. At the basal visit, fever values ranged between 39.5 and 37.8°C, on day 4 between 39.1 to 37.5[compfn]C, and at the end of treatment between 37.5 and 36.5[compfn]C. The basal sputum was positive in eight cases, and on fourth day of therapy; at the end of treatment, any presence of pathogens was detected in the sputum. In the other 30 patients, the isolation of pathogens was performed during the basal visit by bronchoalveolar lavage. On day 4, the tests were still positive, while at the end of treatment only in two cases a pathogen was isolated, but with reduction of the bacterial count. All the isolated pathogens were in vitro susceptible to levofloxacin.

A clinical success was observed in 36/38 cases, with only cough in two cases. The eradication of the pathogen was obtained in 34 patients, and presumed in two ones. The other two cases reported one partial eradication and one colonisation.

Remarkable adverse effects did not occur after administration of levofloxacin: five diarrhoea for 5 days, three reported headache for 2 days (with nausea in one) and one asthenia for 6 days.

In conclusion, on the microbiological findings, on the good clinical efficacy of the drug in the acute exacerbations of the pulmonary infections, on the low resistance rate of causative pathogens to new quinolones and on the high penetration into respiratory tissues, levofloxacin allowed not only to reach the microbiological eradication, but also a clean resolution of the symptoms with a reduction of the postoperative hospitalisation period and a saving of the related costs.

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Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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