Efficacy of Levofloxacin for Experimental Aortic-Valve Endocarditis in Rabbits Infected with Viridans Group Streptococcus orStaphylococcus aureus

Abstract

Levofloxacin is among the more active fluoroquinolones against streptococci and staphylococci. It is effective against moderately severe infections caused by these organisms, but its efficacy in the treatment of bacteremia and serious infections such as endocarditis is not well defined. We compared the efficacy of levofloxacin to those of standard agents in the rabbit model of aortic-valve endocarditis caused by fluoroquinolone-susceptible strains including a penicillin-susceptible strain of Streptococcus sanguis, a penicillin-resistant strain of Streptococcus mitis, a methicillin-resistant strain of Staphylococcus aureus, and a methicillin-susceptible strain of S. aureus. Levofloxacin administered intramuscularly at dosages of 20 to 40 mg/kg of body weight twice daily (b.i.d.) was completely ineffective against the penicillin-susceptible strain, with mean vegetation titers after 3 days of therapy not statistically significantly different from those for controls. Levofloxacin was no more effective than penicillin against the penicillin-resistant strain. Levofloxacin administered for 4 days at a dosage of 20 mg/kg b.i.d. was at least as effective as vancomycin administered intravenously at a dosage of 25 mg/kg b.i.d. against the methicillin-resistant S. aureus strain and was as effective as nafcillin administered intramuscularly at 100 mg three times daily against the methicillin-susceptible strain. Emergence of resistance to levofloxacin in vitro was less likely to occur than resistance to ciprofloxacin, and resistance to levofloxacin was not observed in vivo. Levofloxacin-rifampin combinations were antagonistic in vitro and in vivo. Levofloxacin was highly effective as a single agent against experimental staphylococcal endocarditis but was surprisingly ineffective against streptococcal endocarditis, suggesting that it has a potential role as treatment for serious S. aureus but not viridans group streptococcal infections in humans.

Systemic and local antibiotic prophylaxis in the prevention of Staphylococcus epidermidisgraft infection

“…Although, the difference was not significant, the highest reduction in bacterial number was in the intraperitoneal teicoplanin groups in our study and this finding is parallel with previous studies, [23,37]. Second reason for choosing teicoplanin was its advantage as single dose application.…”

“…Kester et al [34] concluded from a two-centre study that a single dose of teicoplanin showed similar efficacy to a three-dose regimen of cephradine plus metronidazole as prophylaxis for wound infection in vascular surgery. It was showed that levofloxacin had greater in vitro and in vivo anti-staphylococcal activity than the other fluoroquinolones such as ofloxacin or ciprofloxacin [35-37]. In previous studies levofloxacin was reported to reach high concentrations in serum and various tissues, following single dose levofloxacin administration [38,39].…”

Bacteremia Due to Viridans Group Streptococci with Diminished Susceptibility to Levofloxacin among Neutropenic Patients Receiving Levofloxacin Prophylaxis

“…Recent animal experimentation data suggest that the in vivo susceptibility of VG streptococci to levofloxacin (and trovafloxacin) may be suboptimal [19][20][21]. The levofloxacin MIC 90 for VG streptococci is at the susceptibility breakpoint concentration [10], which may facilitate selection of quinolone-resistant mutants [10,22].…”

Response of Complicated Methicillin‐Resistant Staphylococcus aureus Endocarditis to the Addition of Trovafloxacin

“…8 In vitro data show that many newergeneration fluoroquinolones have excellent activity against MRSA and are less likely to develop resistance, [9][10][11][12][13][14] and animal models of endocarditis support their efficacy. [15][16][17][18][19][20] A patient with MRSA right-sided endocarditis complicated by pulmonary infection was cured with the addition of trovafloxacin to his antibiotic regimen.…”