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

Abstract

High-dose, short-course therapy with levofloxacin in subjects with AP is at least as effective as standard 10-day therapy with ciprofloxacin.

The Clinical Guidelines for Acute Uncomplicated Cystitis and Acute Uncomplicated Pyelonephritis

“…But, considering the global expression pattern of fluoroquinolone-resistant E. coli, the use of an initial high dose of fluoroquinolone should be limited. Third generation cephalosporins, such as cefpodoxime proxetil, cefuroxime, and ceftibuten, can be used as an alternative drug (LE: 1b, GR: B) [36,38,39]. However, according to the reports to date, there have been clinically equivalent effects with ciprofloxacin, but bacteriological and efficacious aspects have not been proven.…”

“…In Korea, the resistance rate of fluoroquinolone (6.9-12.9%) and third-generation cephalosporin (ex, cefotaxim: 0.8-10.2%) antibiotics is reported to be around 10% [24,26]. If the dose of fluoroquinolone is increased, the treatment period may be shortened to 5 days (LE: 1b, GR: B) [36,37]. But, considering the global expression pattern of fluoroquinolone-resistant E. coli, the use of an initial high dose of fluoroquinolone should be limited.…”

“…(2) Severe acute uncomplicated pyelonephritis: In patients with severe acute pyelonephritis, without the possibility of oral administration due to systemic symptoms, such as nausea and vomiting, parenteral antibiotics should be considered as the initial treatment (Table 4) [35][36][37][38]41,42]. Hospital admission should be considered if complicating factors cannot be ruled out in diagnostic procedures or if patients have clinical signs and symptoms of sepsis (LE: 4, GR: B).…”

A Review of Levofloxacin for the Treatment of Bacterial Infections

“…In a sub-group of 35 patients with complicated acute pyelonephritis (characterized by obstruction, retention, renal calculi, diabetes, immunocompromised status, presence of catheter, neurogenic bladder, ileal loop, or recent invasive procedure), overall pathogen eradication rates were 95% and 100% for levofl oxacin-and ciprofl oxacintreated patients, respectively. 105 Levofl oxacin, at a daily dose of 500 mg, has been shown effective for treatment of chronic bacterial prostatitis based on clinical and microbiological outcomes (Table 7). 106,107 In a study conducted by Bundrick et al resolution or improvement of symptoms and pathogen eradication, assessed 5-18 days following the completion of treatment, were accomplished in approximately 3 of every 4 men, and clinical response was sustained, as confi rmed by an evaluation made 6 months later.…”

“…The foundation for the safety experience with levofl oxacin was laid during clinical trials (Ͼ7,000 patients) in which adverse events, laboratory testing, vital (296) 98% (157) 97% (165) 96% (157) 93% (165) Levofl oxacin 250 mg qd po × 7-10 days (232) Lomefl oxacin 400 mg qd po × 14 days (229) 93% (171) 89% (165) 95% (171) 92% (165) Levofl oxacin 250 mg qd po × 7-10 days (124) Ciprofl oxacin 500 mg bid po × 10 days (80) Lomefl oxacin 400 mg qd po × 14 days (55) 93% (89) 95% (58) 95% (39) 94% (89) 94% h (97) Levofl oxacin 750 mg qd po and/or IV × 5 days j (146) Ciprofl oxacin 400 mg IV and/or 500 mg po bid × 10 days j (165) 94% (80) 88% ( a Clinical success was defi ned as cure or improvement of symptoms, and bacteriological eradication was defi ned as proven or presumed eradication of the causative pathogens(s), both in microbiologically evaluable patients. The primary endpoint was bacteriological eradication, which was assessed at 5-30 post-treatment in the chronic bacterial prostatitis studies and 5-9 days post-treatment (0-2 days post-treatment for ciprofl oxacin 102,105 ) in the UTI studies. b Number of patients that were randomized and received at least one dose of study medication.…”