Local Antibiotic Delivery for Community Acquired Pneumonia

Prior treatment

• Respiratory rate \>24/min with relevant oxygen therapy
• Known allergy to levofloxacin or other fluoroquinolones or a serious adverse reaction when previously treated with a fluoroquinolone, including tendinitis or tendon-rupture related to fluoroquinolone treatment
• Pregnancy (a negative pregnancy test is required prior to inclusion of all pre-menopausal women)

Other illness

• Positive COVID or influenza test (PCR or antigen test)
• Known allergy to β-lactam antibiotics or to macrolide antibiotics.
• Medical history of myasthenia gravis

Lab values

• Septic shock according to the sepsis III criteria:41 sequential organ failure assessment (SOFA) score ≥2) and suspected infection (according to attending physician) and persisting hypotension requiring vasopressors to maintain MAP≥65 mmHg and serum lactate level\>2 mmol/L (18 mg/dL) despite adequate volume resuscitation (30 mL/kg crystalloid within 3 hours).
• Reduced kidney function (eGFR \< 20)
• Clinically significant cardiac conduction disorders/arrhythmias or prolonged QTc interval (QTc (f) \> 480ms).

Other

• Oxygen requirement ≥5 L/min to maintain acceptable saturation assessed by the treating physician.
• Symptoms of neuropathy (peripheral paraesthesia, hypoesthesia, or hyperalgesia)
• Expected transfer to ICU or death within 48 hours or a do not resuscitate ordination at time of recruitment.
• Suspected aspiration pneumonia, pulmonary abscess, or pleural empyema / complicated parapneumonic effusion.

• Hospital admission within 24 hours.
• Radiologically new-onset chest infiltrate that is consistent with pneumonia and symptoms or signs also consistent with pneumonia, such as fever, cough, sputum, dyspnoea and/or chest pain
• CURB-65 score 3-5
• C-reactive protein \>50 OR central body temperature \>38.0 °C (1-2 of these fulfilled)
• Age ≥ 18 years
• Able to give informed consent.