Efficacy of levofloxacin versus cefuroxime in treating acute exacerbations of chronic obstructive pulmonary disease

Ho Il Yoon,¹ Chang-Hoon Lee,² Deog Kyeom Kim,³ Geun Min Park,⁴ Sang-Min Lee,² Jae-Joon Yim,² Jae-Yeol Kim,⁵ Jae Ho Lee,¹ Choon-Taek Lee,¹ Hee Soon Chung,³ Young Whan Kim,² Sung Koo Han,² Chul-Gyu Yoo<sup>2

1</sup>Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea; ²Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; ³Division of Pulmonology, Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, South Korea; ⁴Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Republic of Korea; ⁵Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea

Background: Antibiotic treatment is one of the major pharmacologic treatments for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, the choice of antibiotic depends on the local resistance pattern. A multicenter, randomized, controlled trial was done in patients with AECOPD to compare the efficacy of levofloxacin with that of cefuroxime axetil.
Methods: Patients with AECOPD and without radiographic evidence of pneumonia were enrolled and randomized to either levofloxacin 500 mg daily or cefuroxime 250 mg twice daily in the mild-moderate exacerbation group, or 500 mg twice daily in the severe exacerbation group, for seven days. Clinical efficacy and microbiologic response were evaluated 5–7 days after the last dose.
Results: Treatment was clinically successful in 90.4% of patients in the levofloxacin group, and in 90.6% of patients in the cefuroxime group (95% confidence interval -9.40 to 10.91), within a noninferiority margin of 10%. The microbiologic response appeared to be higher in the levofloxacin group, but the difference was not statistically significant. The safety profile was similar in both groups.
Conclusion: Levofloxacin is not inferior to cefuroxime with regard to clinical efficacy in treating AECOPD.

Keywords: chronic obstructive pulmonary disease, acute exacerbation, levofloxacin, cefuroxime