A Risk-Benefit Assessment of Levofloxacin in Respiratory, Skin and Skin Structure, and Urinary Tract Infections

Abstract

As a class, the quinolone antibacterials can no longer be assumed to be both effective and relatively free of significant adverse effects. Recent safety issues with newer generation fluoroquinolones, and concerns regarding drug-use associated bacterial resistance have made all drugs in this class subject to intense scrutiny and further study. Levofloxacin is a second generation fluoroquinolone with a post marketing history of well tolerated and successful use in a variety of clinical situations. Quinolones as a class cause a variety of adverse effects, including phototoxicity, seizures and other CNS disturbances, tendonitis and arthropathies, gastrointestinal effects, nephrotoxicity, prolonged QTc interval and torsade de pointes, hypo- or hyperglycaemia, and hypersensitivity reactions. Levofloxacin has been involved in only a few case reports of adverse events, which include QTc prolongation, seizures, glucose disturbances, and tendonitis. Levofloxacin has been shown to be effective at dosages of 250mg to 500mg once-daily in clinical trials in the management of acute maxillary sinusitis, acute bacterial exacerbations of chronic bronchitis, community-acquired pneumonia, skin and skin structure infections, and urinary tract infections. There are data suggesting that levofloxacin may promote fluoroquinolone resistance among the Streptococcus pneumoniae, and that clinical failures may result from this therapy. Other data suggest that fluoroquinolones with lower potency against Pseudomonas aeruginosa than ciprofloxacin, such as levofloxacin, may drive class-wide resistance to this pathogen. Levofloxacin is an effective drug in many clinical situations, but its cost is significantly higher than amoxicillin, erythromycin, or first and second generation cefalosporins. Because of the propensity to select for fluoroquinolone resistance in the pneumococcus and potentially other pathogens, levofloxacin should be an alternative agent rather than a drug-of-choice in routine community-acquired respiratory tract, urinary tract, and skin or skin structure infections. In areas with increasing pneumococcal beta-lactam resistance, levofloxacin may be a reasonable empiric therapy in community-acquired respiratory tract infections. Similarly, in patients with risk factors for infectious complications or poor outcome, levofloxacin may be an excellent empiric choice in severe community-acquired respiratory tract infections, urinary tract infections, complicated skin or skin structure infections, and nosocomial respiratory and urinary tract infections. Better clinical data are needed to identify the true place in therapy of the newer fluoroquinolones in common community-acquired and nosocomial infections. Until then, these agents, including levofloxacin, might best be reserved for complicated infections, infection recurrence, and infections caused by beta-lactam or macrolide-resistant pathogens.

In Vivo Measurement of Levofloxacin Penetration into Lung Tissue after Cardiac Surgery

“…Whether this would lead to an adequate increase in tissue concentration remains to be shown. This is surprising, because levofloxacin should qualify in the mentioned dosage for excellent coverage against gram-positive and gram-negative pathogens (9,13,17). However, the results of the present study could have been strongly influenced by changes in macro-and microcirculation, increased volume of drug distribution, capillary leakage, and atelectasis associated with CABG with CPB.…”

“…Levofloxacin was chosen as the antibiotic because it is effective in the treatment of nosocomial pneumonia caused by susceptible pathogens (9,13,17). As a measuring method, we used in vivo microdialysis, an innovative clinical technique, most suitable to measure interstitial antibiotic concentrations in a clinical setting (14,18).…”

Presence of Antibiotic-Resistant Pathogens in School Cafeteria’s Fast Foods in Dhaka City, Bangladesh: A Growing Concern

“…Proteus spp. are notorious for causing urinary tract infections, and also levofloxacin is used to cure this problem [26]. Horizontal transfer of these resistances to unrelated species is assumed to worsen the situation.…”

Rapid and sensitive determination of levofloxacin in microsamples of human plasma by high‐performance liquid chromatography and its application in a pharmacokinetic study

“…Usually, it is available in four pharmaceutical forms: tablets, intravenous or oral solution, and ophthalmic drops (http://www.drugs.com). Its efficacy has been established at doses from 200 to 750 mg daily in different pathologies; however, the dose can be increased to 1 g daily (Geddes et al ., ; Martin et al ., ). Levofloxacin's mechanism of action includes inhibition of both bacterial DNA gyrase and topoisomerase IV (Hooper, ).…”