Levofloxacin versus combined azithromycin and amoxycillin/clavulanic acid
Description
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 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 to have CAP were randomly assigned to first and second treatment groups. Community acquired pneumonia was diagnosed according to America Thoracic Society criteria. Sample size of 76 was arrived at by Yamane Taro (1967) formular. Every patient diagnosed and treated in outpatient department who gave a 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. Comparison of effectiveness between the two treatment groups was done by independent t-test. Changes in white blood cell count during the follow up visits were done using chi-square test. P value of <0.05 was considered statistically significant. Results. Majority 33(50%) of the patients were aged between 21- 29 years and over sixty percent, 42(63.6%) of participants were females. All the participants, 66(100%) had cough and chest pain, 57(86.4%) had crackles and about ten percent, 6(9.1%) had difficulty in breathing at the time of admission into the study. About 29(43.9%) of patients had fever at baseline and 14(21.2%) had a respiratory rate between 16-29 breaths per minute at baseline. 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 the meantime to 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 (2.21days, 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).
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Patients diagnosed with cap in outpatient were randomly assigned to any of the two treatment groups. they then observed on day 1 day3 and day five to document changes in relation to symptom change