Once a Day Levofloxacin in the Treatment of Mild to Moderate and Severe Community-Acquired Pneumonia in Adults

Fogarty, Charles; Sullivan, James G.; Chattman, Martin S.; Williams, R R; Kojak, Clare; Rubin, Arkady

doi:10.1097/00019048-199811000-00009

Cited by 28 publications

(15 citation statements)

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“…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.…”

Section: Discussionmentioning

confidence: 70%

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

Hutschala

Skhirtladze

Zuckermann

et al. 2005

Antimicrob Agents Chemother

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Nosocomial pneumonia is a severe complication after cardiac surgery (CS). Levofloxacin, a fluoroquinolone, qualifies for the therapy of postoperative pneumonia. However, penetration properties of levofloxacin into the lung tissue could be substantially affected by CS: atelectasis, low cardiac output after CS, high volume loads, and inflammatory capillary leak potentially influence drug distribution. The aim of our study was to gain information on interstitial antibiotic concentrations in lung tissue in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. Therefore, six patients undergoing elective CS participated in this prospective study. A dose of 500 mg of levofloxacin was administered intravenously in addition to standard antibiotic prophylaxis immediately after the end of surgery. Time versus concentration profiles of levofloxacin in the interstitial lung tissue and plasma were determined. A microdialysis technique was used for lung interstitial concentration measurements. The microdialysis procedure was well tolerated in all patients and no adverse events were observed. The median area under the concentration curve (AUC) of levofloxacin in interstitial lung fluid was 18.6 g · h/ml (range, 10.1 to 33.6). The median AUC for tissue (AUC tissue ) of unbound levofloxacin/AUC total in plasma was 0.6 (range, 0.4 to 0.9). The median unbound AUC tissue /MIC was 2.4 (range, 1.3 to 4.2) for Pseudomonas aeruginosa. Our study demonstrated the feasibility and safety of microdialysis in human lung tissue in vivo after CS. The unbound AUC/MIC ratio revealed that levofloxacin used in the described manner was borderline sufficient for the treatment of nosocomial pneumonia caused by Klebsiella pneumoniae and insufficient for the treatment of pneumonia caused by Pseudomonas aeruginosa, because the breakpoint of 30 to 40 for AUC/MIC could not be reached by the conventionally used dosage schema in our post-CS setting. Penetration was lower than in previous reports.

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Section: Discussionmentioning

confidence: 70%

“…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).…”

mentioning

confidence: 99%

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

Hutschala

Skhirtladze

Zuckermann

et al. 2005

Antimicrob Agents Chemother

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“…When administered as single drug therapy, all clinical trials published have shown it to be as effective in the treatment of communityacquired pneumonia as ceftriaxone, amoxicillin-clavulanate, azithromycin or clarithromycin alone or in combination [8][9][10][11]25]. Levofloxacin also has additional advantages over some comparators with regard to toxicity and economic cost [26].…”

Section: Discussionmentioning

confidence: 99%

Levofloxacin versus ceftriaxone plus clarithromycin in the treatment of adults with community-acquired pneumonia requiring hospitalization

Querol-Ribelles

Tenías

Querol-Borras

et al. 2005

International Journal of Antimicrobial Agents

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“…46 Levofl oxacin has been evaluated in numerous clinical studies in patients with mild-to-severe CAP, initially administered at a daily dose of 500 mg for 7-14 days (Table 3). [47][48][49][50][51][52][53][54][55] Recently, based on the pharmacokinetic and pharmacodynamic principles discussed above, it has been studied at a daily dose of 750 mg for 5 days (Table 3). 56 In these studies, levofl oxacin was shown to be at least non-inferior, and in some trials superior, to the comparator regimen, including β-lactams (i.e.…”

Section: Community-acquired Pneumonia (Cap)mentioning

confidence: 99%

“…Levofl oxacin 500 mg qd × 7-14 days (102) Ceftriaxone IV 1000 mg qd plus azithromycin 500 mg IV qd × 2-5d then azithromycin 500 mg po qd to complete 7-10 days total m (110) 89% (75) 92% (82) NR NR Levofl oxacin 500 mg qd × 7-14 days (199) Moxifl oxacin 400 mg qd IV/po × 7-14 days (195) 88% (140) 93% (141) 75% (28) 81% (21) a The primary endpoint was clinical response (success) in clinically evaluable patients (per-protocol population), assessed at 2-28 days post-therapy, with the exception of the study by Fogarty et al, 48 in which the primary endpoint was bacteriologic eradication in microbiologically evaluable patients. Clinical success was defi ned as cure or improvement of symptoms.…”

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confidence: 99%

A Review of Levofloxacin for the Treatment of Bacterial Infections

Noel

2009

Clinical Medicine. Therapeutics

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Abstract:Completing its initial phases of drug development in the mid 1990s as the one of the fi rst fl uoroquinolones that could be used with confi dence to treat respiratory tract infections, levofl oxacin went on to become one of the most widely prescribed antibiotics in the world. Available in both oral (po) and intravenous (IV) formulations and with characteristics of over 90% bioavailability, distribution into both extracellular and intracellular pulmonary compartments, highly predictable pharmacokinetics with over 90% of the drug being excreted unchanged in urine, and reliable activity against a broad spectrum of clinically important pathogens, levofl oxacin has been used successfully to treat patients with a variety of serious infectious diseases as well as common infections most often treated outside of the hospital setting. Results of clinical trials involving patients with respiratory tract, urinary tract, and skin infections have consistently shown rates of clinical success and bacteriological eradication that were comparable to other widely used broad-spectrum agents. Regimens of levofl oxacin, initially involving total daily doses of 250 mg to 500 mg, but more recently regimens involving 750 mg doses, have been shown to be safe and effective. Nearly a decade and a half of clinical experience has defi ned a safety and tolerability profi le that permits data-driven assessment of the risks and benefi ts of using levofl oxacin. As resistance to currently available fl uoroquinolones has emerged, the clinical value of levofl oxacin deserves continued evaluation. However, consistently high rates of susceptibility of clinically important bacteria, especially among those bacteria that commonly cause respiratory tract infections, such as Streptococcus pneumoniae and Haemophilus infl uenzae, suggest that this agent will continue to be a widely used well past the 20-year anniversary of its introduction into the antibacterial armamentarium.

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Once a Day Levofloxacin in the Treatment of Mild to Moderate and Severe Community-Acquired Pneumonia in Adults

Cited by 28 publications

References 0 publications

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

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

Levofloxacin versus ceftriaxone plus clarithromycin in the treatment of adults with community-acquired pneumonia requiring hospitalization

A Review of Levofloxacin for the Treatment of Bacterial Infections

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