Outcomes of Levofloxacin-Based Regimens in Adults With Severe Community-Acquired Pneumonia Requiring ICU Admission: A Single-Center Retrospective Cohort From Jazan, Saudi Arabia

Ahmed Hakami (1), Amnah Numan , Shoroog Obaidullah (2), Shahad Numan (3), Ahmad Alharbi (4), Hanan Hakami (5), Hanan Bakri (6), Nawal Hakami (7), Mousa Zamili (8), Abdulmajeed Alanazi (9), Munif Ayyashi (10), Ali Mohammed Qassim Hazzazi (11)
(1) Abu arish General Hospital, Jazan Health Cluster,Ministry of Health, Saudi Arabia,
(2) King Saud Medical City (KSMC), Ministry of Health, Saudi Arabia,
(3) College of medicine, Jazan University, Saudi Arabia,
(4) Buridah Central Hospital, Qassim Health Cluster, Qassim, Ministry of Health, Saudi Arabia,
(5) Salah Al-Din Health Care Center, Riyadh Second Health Cluster, Riyadh, Ministry of Health, Saudi Arabia,
(6) King Fahd Central Hospital, Jazan,Ministry of Health, Saudi Arabia,
(7) King Fahd Central Hospital, Jazan Health Cluster, Jazan, Ministry of Health, Saudi Arabia,
(8) Abu arish General Hospital, Jazan Health Cluster, Jazan, Ministry of Health, Saudi Arabia,
(9) Dumat Aljandal General Hospital, Aljouf Health Cluster, Aljouf, Ministry of Health, Saudi Arabia,
(10) Jazan Specialist Hospital, Jazan Health Cluster,Ministry of Health, Saudi Arabia,
(11) Abu-Arish General Hospital, Ministry of Health, Saudi Arabia

Abstract

Background


Levofloxacin is widely used in combination regimens for severe community-acquired pneumonia (CAP) in the ICU; however, real-world outcome data from resource-limited settings remain scarce.


Objective:


To evaluate 28-day mortality and key clinical/safety outcomes among adults with severe CAP requiring ICU admission who received levofloxacin-based regimens at Abu-Arish General Hospital.


 


Methods


We conducted a retrospective cohort study that examined patient data captured through an electronic medical system at the Abu Arish General Hospital between 2021 and 2022 (Single‑center retrospective cohort (dates), Abu‑Arish General Hospital ICU). We used the repeated measures ANCOVA to investigate the effect of Levofloxacin on a wide range of medical parameters. Data analysis was performed with SPSS statistics (Version 25).


Results


A total of 93 patients were included in this study. The study examined the impact of levofloxacin on various medical parameters, including age, weight, height, BMI, initial dosage, comorbid diseases and sex. The adjusted mean differences between before and after Levofloxacin administration revealed significant changes in a variety of medical parameters, including hepatic markers and hematologic indices.


Conclusion


Levofloxacin therapy can produce change in baseline clinical characteristics of critical ill patients in the intensive care unit. We need to investigate the tolerability of this therapy in terms the severity of side effects on a large sample of the critically ill patients in the future. This study 


will allow healthcare providers to give better care to these patients.

Full text article

Generated from XML file

References

M. Bassetti, F. Magnè, D. R. Giacobbe, L. Bini, and A. Vena, “New antibiotics for Gram-negative pneumonia,” European Respiratory Review, vol. 31, no. 166. 2022, doi: 10.1183/16000617.0119-2022.

A. C. Rider and B. W. Frazee, “Community-Acquired Pneumonia,” Emergency Medicine Clinics of North America, vol. 36, no. 4. pp. 665–683, 2018, doi: 10.1016/j.emc.2018.07.001.

O. Paper, “Pneumonia as the Most Common Lower,” vol. 67, no. 6. pp. 442–445, 2013.

Alshammari, M. K., Alotaibi, M. A., AlOtaibi, A. S., Alosaime, H. T., Aljuaid, M. A., Alshehri, B. M., AlOtaibi, Y. B., Alasmari, A. A., Alasmari, G. A., Mohammed, M. H., Althobaiti, S. M., Almuhaya, R. A., Alkhoshi, T. A., Alosaimi, A. S., & Alotaibi, A. A. (2023). Prevalence and Etiology of Community- and Hospital-Acquired Pneumonia in Saudi Arabia and Their Antimicrobial Susceptibility Patterns: A Systematic Review. Medicina (Kaunas, Lithuania), 59(4), 760. https://doi.org/10.3390/medicina59040760

M. K. Alshammari et al., “Prevalence and Etiology of Community- and Hospital-Acquired Pneumonia in Saudi Arabia and Their Antimicrobial Susceptibility Patterns: A Systematic Review,” Med., vol. 59, no. 4, pp. 1–15, 2023, doi: 10.3390/medicina59040760.

L. A. Mandell et al., “Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the management of community-acquired pneumonia in adults,” Clin. Infect. Dis., vol. 44, no. SUPPL. 2, 2007, doi: 10.1086/511159.

S. T. Micek, K. E. Kollef, R. M. Reichley, N. Roubinian, and M. H. Kollef, “Health care-associated pneumonia and community-acquired pneumonia: A single-center experience,” Antimicrob. Agents Chemother., vol. 51, no. 10, pp. 3568–3573, 2007, doi: 10.1128/AAC.00851-07.

C. Cillóniz, A. Torres, and M. S. Niederman, “Management of pneumonia in critically ill patients,” BMJ, vol. 375, p. e065871, 2021, doi: 10.1136/bmj-2021-065871.

Macesic, N., Uhlemann, A. C., & Peleg, A. Y. (2025). Multidrug-resistant Gram-negative bacterial infections. Lancet (London, England), 405(10474), 257–272. https://doi.org/10.1016/S0140-6736(24)02081-6

J. A. Rebuck, D. N. Fish, and E. Abraham, “Pharmacokinetics of intravenous and oral levofloxacin in critically ill adults in a medical intensive care unit,” Pharmacotherapy, vol. 22, no. 10, pp. 1216–1225, 2002, doi: 10.1592/phco.22.15.1216.33484.

Baggio, D., & Ananda-Rajah, M. R. (2021). Fluoroquinolone antibiotics and adverse events. Australian prescriber, 44(5), 161–164. https://doi.org/10.18773/austprescr.2021.035

Maitre, T., Godmer, A., Mory, C., Chauffour, A., Mai, T. C., El Helali, N., Aubry, A., & Veziris, N. (2024). Levofloxacin activity at increasing doses in a murine model of fluoroquinolone-susceptible and -resistant tuberculosis. Antimicrobial agents and chemotherapy, 68(11), e0058324. https://doi.org/10.1128/aac.00583-24

Roberts JA, Cotta MO, Cojutti P, Lugano M, Della Rocca G, Pea F. Does Critical Illness Change Levofloxacin Pharmacokinetics? Antimicrob Agents Chemother. 2015 Dec 14;60(3):1459-63. doi: 10.1128/AAC.02610-15. PMID: 26666946; PMCID: PMC4775952.

V. R. Anderson and C. M. Perry, “Levofloxacin: A review of its use as a high-dose, short-course treatment for bacterial infection,” Drugs, vol. 68, no. 4. pp. 535–565, 2008, doi: 10.2165/00003495-200868040-00011.

P. D. Tamma, S. L. Aitken, R. A. Bonomo, A. J. Mathers, D. Van Duin, and C. J. Clancy, “Infectious Diseases Society of America 2022 Guidance on the Treatment of Extended-Spectrum β-lactamase Producing Enterobacterales (ESBL-E), Carbapenem-Resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with Difficult-to-Treat Resistance (DTR-P. aeruginosa),” Clin. Infect. Dis., vol. 75, no. 2, pp. 187–212, 2022, doi: 10.1093/cid/ciac268.

D. N. Fish, “Fluoroquinolone adverse effects and drug interactions,” Pharmacotherapy, vol. 21, no. 10 II SUPPL. 2001, doi: 10.1592/phco.21.16.253s.33993.

C. Jun and B. Fang, “Current progress of fluoroquinolones-increased risk of aortic aneurysm and dissection,” BMC Cardiovasc. Disord., vol. 21, no. 1, pp. 1–10, 2021, doi: 10.1186/s12872-021-02258-1.

J. Segreti, “A multicenter, randomized study comparing the efficacy and safety of intravenous and/or oral levofloxacin versus ceftriaxone and/or cefuroxime axetil in treatment of adults with community-acquired pneumonia,” Infect. Dis. Clin. Pract., vol. 7, no. 2, pp. 88–89, 1998, doi: 10.1097/00019048-199802000-00005.

T. Neto Gonçalves, D. Sousa, N. Marto, and A. B. Horta, “Levofloxacin-Induced Acute Pancreatitis,” Cureus, vol. 13, no. 2, pp. 12–14, 2021, doi: 10.7759/cureus.13301.

Rissardo, J. P., & Caprara, A. L. F. (2023). Fluoroquinolone-Associated Movement Disorder: A Literature Review. Medicines (Basel, Switzerland), 10(6), 33. https://doi.org/10.3390/medicines10060033

Y. Hirano et al., “Toxic epidermal necrolysis induced by tirabrutinib,” J. Dermatol., vol. 49, no. 4, pp. e135–e136, 2022, doi: 10.1111/1346-8138.16274.

A. A. Khan, U. Aisha, A. Hassan, Z. Haider, and D. E. Cook, “Levofloxacin-Induced Toxic Epidermal Necrolysis,” Cureus, vol. 15, no. 5, pp. 4–9, 2023, doi: 10.7759/cureus.39504.

Anita Karim, Shahid Ahmed, Leonard J. Rossoff, Rina K. Siddiqui, Harry N. Steinberg, Possible Levofloxacin-Induced Acute Hepatocellular Injury in a Patient with Chronic Obstructive Lung Disease, Clinical Infectious Diseases, Volume 33, Issue 12, 15 December 2001, Pages 2088–2090, https://doi.org/10.1086/338156

ABD EL FADIL, H., M. MAHMOUD, N., & MOHAMED ABD EL-MOTTLEB, D. (2020). AMELIORATIVE EFFECT OF VITAMIN E AGAINST SOME ADVERSE EFFECTS OF LEVOFLOXACIN IN MALE RATS. Assiut Veterinary Medical Journal, 66(165). https://doi.org/10.21608/avmj.2020.166394

Clark, P. (2002). Fundamentals of Veterinary Clinical Pathology. Australian Veterinary Journal, 80(12). https://doi.org/10.1111/j.1751-0813.2002.tb11349.x

Daugirdas, J. T. (2018). Handbook of chronic kidney disease management. In Handbook of Chronic Kidney Disease Management. https://doi.org/10.12968/jorn.2011.3.4.204

Ferguson, M. A., & Waikar, S. S. (2012). Established and emerging markers of kidney function. In Clinical Chemistry (Vol. 58, Issue 4). https://doi.org/10.1373/clinchem.2011.167494

Ahmed, M. H., Resen, A. K., & Al-Niaeem, K. S. (2022). Effects of antibiotic residues on some health parameters of Planiliza abu H. in Shatt Al-Arab, Southern Iraq. Caspian Journal of Environmental Sciences, 20(5). https://doi.org/10.22124/cjes.2022.6080

Memon, N., Weinberger, B. I., Hegyi, T., & Aleksunes, L. M. (2016). LiverTox: Clinical and Research Information on DrugInduced Liver Injury [Internet]. In Pediatr Res. (Vol. 176, Issue 1).

Karim A, Ahmed S, Rossoff LJ, Siddiqui RK, Steinberg HN. Possible levofloxacin-induced acute hepatocellular injury in a patient with chronic obstructive lung disease. Clin Infect Dis. 2001;33:2088–90.

Authors

Ahmed Hakami
Ahmed.Ali.Hakami@hotmail.com (Primary Contact)
Amnah Numan
Shoroog Obaidullah
Shahad Numan
Ahmad Alharbi
Hanan Hakami
Hanan Bakri
Nawal Hakami
Mousa Zamili
Abdulmajeed Alanazi
Munif Ayyashi
Ali Mohammed Qassim Hazzazi
Hakami, A., Numan, A., Obaidullah, S., Numan, S., Alharbi, A., Hakami, H., … Hazzazi, A. M. Q. (2025). Outcomes of Levofloxacin-Based Regimens in Adults With Severe Community-Acquired Pneumonia Requiring ICU Admission: A Single-Center Retrospective Cohort From Jazan, Saudi Arabia. Saudi Journal of Medicine and Public Health, 2(2), 596–604. https://doi.org/10.64483/jmph-165

Article Details

Similar Articles

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)