Is it appropriate to use levofloxacin (Levaquin) and ceftriaxone (Rocephin) together in the treatment of community-
acquired pneumonia (CAP) and/or neutropenia? Or is the combined use of these drugs redundant?—Charles E. Smith, MD, Holdrege, Neb.

A third-generation cephalosporin plus a quinolone is not presently recommended for the conditions described. CAP guidelines recently issued by the American Thoracic Society and the Infectious Diseases Society of America specifically cover the issue of empiric choices for patients admitted with pneumonia (Clin Infect Dis. 2007;44:S27-S72). Ceftriaxone plus a macrolide will provide excellent coverage for the usual pathogens as well as atypicals. Levofloxacin is a reasonable choice for patients to cover both pathogens; however, clinical failure
with fluoroquinolones has been described.

Neutropenic fever is a different entity. Antibiotic selection should be based on the local institution’s antibiogram.
—Cedric W. Spak, MD, MPH

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