Antimicrobial Therapy - The Ultimate Reference

Urinary Tract Infection

Levofloxacin is indicated for adults with acute pyelonephritis, uncomplicated and complicated urinary tract infections. The efficacy of levofloxacin for these infections is comparable to that of other fluoroquinolones. Compared with piperacillin/tazobactam for the treatment of urosepsis, levofloxacin has the advantage of cost saving in the hospital perspective.

Clinical Trials for UTI

A double-blind, randomized comparison of levofloxacin 750 mg once-daily for five days with ciprofloxacin 400/500 mg twice-daily for 10 days for the treatment of complicated urinary tract infections and acute pyelonephritis. Urology. 2008;71(1):17-22

Outcomes of complicated urinary tract infections and acute pyelonephritis treated with 5-day levofloxacin (750 mg qd) and 10-day ciprofloxacin (400/500 mg bid), respectively, were comparable.

A trial of levofloxacin 750 mg once daily for 5 days versus ciprofloxacin 400 mg and/or 500 mg twice daily for 10 days in the treatment of acute pyelonephritis. Curr Med Res Opin. 2007;23(11):2637-45..

For patients with acute pyelonephritis, 5-day levofloxacin 750 mg once daily is as effective as standard 10-day ciprofloxacin therapy.

Early discharge of hospitalised patients with community-acquired urosepsis when treated with levofloxacin in sequential therapy. Arch Ital Urol Androl. 2006;78(3):112-4.

Compared with standard treatment (piperacillin/tazobactam plus amikacin) for urosepsis, sequential levofloxacin offered similar efficacy and earlier hospital discharge.

Levofloxacin-imipenem combination prevents the emergence of resistance among clinical isolates of Pseudomonas aeruginosa. Clin Infect Dis 2005;40 (Suppl 2):S105-14.

In vitro plus PK/PD studies showed that the combination of levofloxacin plus imipenem was bactericidal against Pseudomonas aeruginosa resistant to both levofloxacin and imipenem.

Pharmacokinetics for UTI

Concentrations in plasma, urinary excretion and bactericidal activity of levofloxacin (500 mg) versus ciprofloxacin (500 mg) in healthy volunteers receiving a single oral dose. Int J Antimicrob Agents. 2006;28(6):551-9. Epub 2006 Nov 13.

This study suggested both levofloxacin (500 mg) and ciprofloxacin (500 mg) may have comparable efficacies for treatment of complicated urinary tract infections.

Pharmacokinetics of ciprofloxacin XR (1000 mg) versus levofloxacin (500 mg) in plasma and urine of male and female healthy volunteers receiving a single oral dose. Int J Antimicrob Agents. 2006;27(1):7-14. Epub 2005 Dec 15.

For treatment of urinary tract infections, ciprofloxacin XR (1000 mg) and levofloxacin (500 mg) may have equivalent effects.

Reviews for UTI

Appropriate antibiotic treatment of genitourinary infections in hospitalized patients. Am J Med. 2005;118 Suppl 7A:14S-20S. Review.

Fluoroquinolones, particularly levofloxacin and gatifloxacin, are recommended for patients hospitalized for pyelonephritis or bacterial prostatitis owning to their broad antibacterial spectrum, reliable urine concentration, and cost-effectiveness.

Rational antibiotic treatment of outpatient genitourinary infections in a changing environment. Am J Med. 2005;118 Suppl 7A:7S-13S. Review.

Trimethoprim-sulfamethoxazole and fluoroquinolones (levofloxacin and gatifloxacin) are preferred therapeutic options for outpatients with prostatitis due to their appropriate bactericidal activity and good prostate penetration (particularly levofloxacin).

Prostatitis

Clinical Trials for Prostatitis

Treatment for chronic prostatitis/chronic pelvic pain syndrome: levofloxacin, doxazosin and their combination. Urol Int. 2008;80(2):157-61. Epub 2008 Mar 19.

Patients with chronic prostatitis/chronic pelvic pain syndrome treated 6-week levofloxacin responded significantly well than those treated with doxazosin and their combination.

Treatment of chronic bacterial prostatitis with levofloxacin and ciprofloxacin lowers serum prostate specific antigen. J Urol. 2005;174(1):161-4.

Levofloxacin and ciprofloxacin offered similar efficacies as treatment for chronic bacterial prostatitis, and an association between bacterial persistence and PSA normalization was observed.

Levofloxacin versus ciprofloxacin in the treatment of chronic bacterial prostatitis: a randomized double-blind multicenter study. Urology. 2003;62(3):537-41.

In this randomized double-blind multicenter study, both levofloxacin was as effective and safe as ciprofloxacin as treatment of chronic bacterial prostatitis.

Levofloxacin for chronic prostatitis/chronic pelvic pain syndrome in men: a randomized placebo-controlled multicenter trial. Urology. 2003;62(4):614-7.

In this placebo-controlled trial, levofloxacin did not demonstrate better efficacy, statistically or clinically, for patients with chronic prostatitis/chronic pelvic pain syndrome than placebo.

Reviews for Prostatitis

Management of bacterial prostatitis: what's new? BJU Int. 2008;101 Suppl 3:7-10. Review.

The article recommended fluoroquinolones as the first choice of therapy for chronic bacterial prostatitis, and levofloxacin is preferred owning to its similar efficacy as ciprofloxacin, better prostatic penetration, and once daily use.

Community-acquired pneumonia

Does empirical treatment of community-acquired pneumonia with fluoroquinolones delay tuberculosis treatment and result in fluoroquinolone resistance in Mycobacterium tuberculosis? Controversies and solutions.

Previous exposure to a quinolone for >10 days in patients with TB is associated with the emergence of quinolone-resistant M. tuberculosis isolates. Macrolide-resistant S pneumoniae and beta-lactam-resistant H influenzae are common in SE Asia. Rates of M. tuberculosis isolates with quinolone resistance are significantly higher amongst multidrug-resistant M. tuberculosis isolates than amongst susceptible isolates. Consequently, in Taiwan and also in other countries with TB endemicity, a short-course (5-day) regimen of a respiratory tract quinolone is still recommended for empirical therapy for CAP patients if the patient is at low risk for TB.

Severe pneumococcal pneumonia: impact of new quinolones on prognosis. BMC Infect Dis 2011;11(1):66.

In a retrospective study of 70 consecutive patients with community-acquired pneumonia admitted to the ICU, levofloxacin use led to lower mortality than either ofloxacin or ciprofloxacin in severe pneumococcal pneumonia when combined to a beta-lactam.

Levofloxacin for the treatment of Mycoplasma pneumoniae-associated meningoencephalitis in childhood. Int J Antimicrobe Agents 2011;Mar 3.

Macrolides have historically been the accepted therapy for Mycoplasma pneumoniae infections, but concerns about macrolide resistance and low CSF concentrations prompted the administration of IV levofloxacin in 5 children for this neurologic complication. Resolution of symptoms was the outcome for all 5 children.

Medical resource utilization among community-acquired pneumonia patients initially treated with levofloxacin 750 mg daily versus ceftriaxone 1000 mg plus azithromycin 500 mg daily: a US-based study. Frei CR, Jaso TC, Mortensen EM, Restrepo MI, Raut MK, Oramasionwu CU, Ruiz AD, Makos BR, Ruiz JL, Attridge RT, Mody SH, Fisher A, Schein JR.

Length of intravenous antibiotic therapy and length of hospital stay was significantly shorter in patients with community-acquired pneumonia initially treated with daily levofloxacin 750 mg than those treated with daily ceftriaxone 1000 mg plus azithromycin 500 mg.

Reviews

Levofloxacin : a review of its use as a high-dose, short-course treatment for bacterial infection. Drugs. 2008;68(4):535-65.

The paper extensively reviewed the efficacies of 5-day levofloxacin at a dose of 750 mg once daily for CAP, ABS, complicated UTI and AP, and concluded its usefulness in the clinical settings.

Respiratory Infections

In Vitro Pharmacodynamics of Levofloxacin and Other Aerosolized Antibiotics under Multiple Conditions Relevant to Chronic Pulmonary Infection in Cystic Fibrosis. Antimicrob Agents Chemother 2010;54(1):143-148.

Levofloxacin was the most potent antibiotic against all antipseudomonal antibiotics tested against bacteria found in the lungs of cystic fibrosis patients and the least affected by biofilms. Levofloxacin concentrations achievable by aerosol administration to the lung showed high bactericidal activity against Pseudomonas aeruginosa, Burkholderia cepacia, MRSA, Stenotrophomonas maltophilia.

Steady-State Plasma and Intrapulmonary Concentrations of Levofloxacin and Ciprofloxacin in Healthy Adult Subjects*. Gotfried MH, Danziger LH, Rodvold KA. CHEST 2001;119:1114-1122.

Levofloxacin was more extensively distributed into intrapulmonary compartments than ciprofloxacin and achieved significantly higher steady-state concentrations in plasma and ELF during the 24 h after drug administration.

Gastrointestinal Infections

Clinical trial: clarithromycin vs. levofloxacin in first-line triple and sequential regimens for Helicobacter pylori eradication. Molina-Infante J, Perez-Gallardo B, Fernandez-Bermejo M, Hernandez-Alonso M, Vinagre G, Dueñas C, Mateos-Rodriguez JM, Gonzalez-Garcia G, Abadia EG, Gisbert JP.

Compared with standard triple scheme, levofloxacin-based and sequential therapy as first-line therapy for Helicobacter pylori infection achieved significantly higher eradication rates while caused no differences in compliance and adverse effects.

Levofloxacin based sequential and triple therapy compared with standard plus probiotic combination for helicobacter pylori eradication. Ozdil K, Calhan T, lSahin A, Senates E, Kahraman R, Yüzbasioglu B, Demirdag H, Demirsoy H, Sökmen MH. Hepatogastroenterology 2011;58(109):1148-52

Ocular Infections

Tear Concentration and Safety of Levofloxacin Ophthalmic Solution 1.5% Compared With Ofloxacin Ophthalmic Solution 0.3% After Topical Administration in Healthy Adult Volunteers. Walters T, Rinehart M, Krebs W, Holdbrook M. Cornea. 2010;29(3):263-268.

The tear concentration and safety of levofloxacin ophthalmic solution 1.5% were compared to ofloxacin 0.3% in 125 healthy adults. A single dose of levofloxacin 1.5% produced tear fluid concentrations that were well above the MIC90 for typical ocular pathogens and was safe and well tolerated.

Cravit and Levoquin (levofloxacin)