- Immunity to UTI Antibiotics? (UTI = Urinary Tract Infection)
- Levofloxacin Rating Summary
- Levofloxacin in the treatment of complicated urinary tract infections and acute pyelonephritis
- User Reviews for Levofloxacin to treat Urinary Tract Infection (Page 2)
- Reviews for Levofloxacin
- Levofloxacin in uti ppt to pdf
- A Review of Levofloxacin for the Treatment of Bacterial Infections
Levofloxacin is a widely used fluoroquinolone approved for the treatment of complicated urinary tract infections and acute pyelonephritis.
Immunity to UTI Antibiotics? (UTI = Urinary Tract Infection)
A comprehensive review of the medical literature identified five publications evaluating levofloxacin for the treatment of either complicated urinary tract infections or acute pyelonephritis.
All trials, although variable in their inclusion criteria and levofloxacin dosing strategies, reported microbiologic, clinical, and safety-related outcomes.
High microbiologic eradication rates, ranging from Escherichia coli was the most commonly isolated uropathogen.
Data on levofloxacin resistance, both at baseline and after therapy, were limited. Clinical success was observed to range from These clinical and microbiologic results were comparable to the fluoroquinolone comparators in all trials. Insufficient data are available to evaluate the outcomes in any meaningful patient subgroups, including catheterized patients, and those with other specific complicating factors.
Levofloxacin was well tolerated in these studies, with headache, gastrointenstinal effects, and dizziness being the most commonly reported adverse events. The published data support the use of levofloxacin in complicated urinary tract infections and acute pyelonephritis. Further trials are necessary to evaluate levofloxacin within specific patient sub-populations. Urinary tract infections are one of the most frequently occurring bacterial infections. While the majority of these infections are uncomplicated, patients with complicated urinary tract infections cUTI are, by definition, at greater risk for adverse outcomes.
Levofloxacin, a widely-used fluoroquinolone, was approved in the US for the treatment of cUTI and acute pyelonephritis AP in and, more recently, in a higher dose, short-course regimen was also approved for this indication. This review will examine the clinical data available to evaluate the efficacy and safety of this antimicrobial for cUTI and AP.
Generally, a cUTI is considered to be an infection that occurs in the setting of any factor that predisposes to treatment failure or recurrence McCue However, no true consensus has been reached within the medical community as to what specifically defines a cUTI. Traditionally, urinary tract infections in patient populations such as those with diabetes mellitus, pregnant females, and males have been considered to be complicated infections Anderson Other descriptions of a cUTI have also included patients who are elderly, have experienced recent instrumentation or antimicrobial treatment, or possess functional or anatomic abnormalities of the genitourinary tract Hooton and Stamm Ronald et al proposed an alternate classification scheme, in which a cUTI is characterized by the presence of structural abnormalities urinary obstructions, neurogenic bladder, etc.
AP was formerly treated largely on an inpatient basis, but a recent trend towards outpatient management of this condition has been noted Czaja et al The fluoroquinolones gemifloxacin and moxifloxacin are not approved for either condition.
The S enantiomer of ofloxacin displays antibacterial activity that is approximately 2 orders of magnitude greater than that of the R enantiomer; this enhanced activity is due to greater binding to and saturation of the binding site on the DNA gyrase enzyme Morrissey et al Studies of ofloxacin were not included in the present analysis.
In patients that are to be hospitalized, the guidelines recommend the use of intravenous therapy with a fluoroquinolone, an aminoglycoside with or without ampicillin, or an extended-spectrum penicillin with or without an aminoglycoside. Alternatives are recommended for each of the above patient populations if the infecting organism is known to be a Gram-positive coccus. IDSA is currently working towards assembling guidelines for the treatment of cUTI, and publication is anticipated in late The European Association of Urology EAU has published guidelines that include recommendations for cUTI, which advise the use of fluoroquinolones with mainly renal excretion when empiric therapy is necessary.
Fluoroquinolones have been extensively used in the management of genitourinary infections, especially acute uncomplicated cystitis.
Levofloxacin Rating Summary
While fluoroquinolone resistance in uropathogens was once rare, resistance in E. Plasmid-borne resistance has also recently been discovered, and is caused by protection of DNA gyrase and topoisomerase IV by Qnr-like proteins, including QnrA Chenia et al Surveillance of urinary isolates collected between and found that fluoroquinolone resistance in E. Similar increases in fluoroquinolone resistance have been noted in the setting of AP Czaja et al Levofloxacin possesses activity against a variety of uropathogens, including E.
Levofloxacin displays linear pharmacokinetics, and an elimination half-life of 7. Levofloxacin also attains adequate penetration into the prostate, with a mean 2.
Renal clearance of levofloxacin but not the plasma C max is reduced in the presence of renal impairment.
Levofloxacin in the treatment of complicated urinary tract infections and acute pyelonephritis
Few current guidelines describing the optimal treatment of cUTI and AP are available, and the role of levofloxacin in comparison to alternate antimicrobials including other fluoroquinolones in the management of these conditions must be further defined.
The objective of this review is to provide a summary of the clinical efficacy and safety of levofloxacin in the treatment of cUTI and AP.
The search criteria were chosen to maximize the sensitivity of the search. We excluded studies performed in pediatric patients or that included no comparator group.
The citations of all included publications were also considered for inclusion in this review.
All publications were assessed for potential duplication of reported data. Data extraction was conducted in this manner so as to evaluate not only the safety and efficacy but also the generalizability of the studies to general practice.
The PubMed query yielded publications.
Of these, five publications met the inclusion and exclusion criteria. However, one of these publications reported the findings of a subset of patients those with AP and these data were also subsequently published with the results of the full trial Klausner et al ; Peterson et al Thus, only the latter publication was included in this review Peterson et al The query of the Cochrane Database of Clinical Trials yielded 55 publications.
Of these, eight studies were not included because levofloxacin was not evaluated, seven were excluded because they were not studies of cUTI or AP, 13 were non-English publications, and the remaining 27 studies had already been identified for consideration in the PubMed query. Similarly, the ClinicalTrials.
Of these trials, 47 were not studies of cUTI or AP, four were conducted in pediatric patients, five were studies not including levofloxacin, and one was an uncontrolled study. Only three trials were identified as having met inclusion and exclusion criteria. The findings of these trials were published, either in whole or in part, in the publications identified through PubMed.
Thus, the summary data available through ClinicalTrials. Review of the cited publications yielded one additional, previously unidentified publication that met inclusion and exclusion criteria.
User Reviews for Levofloxacin to treat Urinary Tract Infection (Page 2)
Five publications met all inclusion and exclusion criteria and are included in this review Klimberg et al ; Richard et al a , b ; Peng ; Peterson et al Table 1 summarizes the design of the trials reported in these publications.
All five publications reported the findings of randomized controlled trials. One reported the results of two such trials Richard et al b ; thus six trials were described among the five publications. We should also note that three of the publications included in this review arise from two trials.
More specifically, data from two trials for the subset of AP patients were published in one publication Richard et al b and the data pertaining to the cUTI patients from each of these trials were published separately Klimberg et al ; Richard et al a.
From this point forward, we will consider these three publications as presenting the results of four distinct trials.
Improved incomplete resolution of signs and symptoms and no requirement for further antibiotic therapy. Cured resolution of pretreatment clinical signs and symptoms without additional antibacterial therapy.
Improved incomplete resolution of symptoms and no requirement for further antibiotic therapy. Improved incomplete resolution of signs and symptoms but no need for additional antibiotic therapy.
Three trials were conducted in the US Klimberg et al ; Richard et al b ; Peterson et al , two trials in the US and Canada Richard et al b , and one trial was conducted in Taiwan Peng The latter was also the only single-center trial.
One of these publications did not achieve the sample size targeted by their power calculation Richard et al a. The remaining trials, which were all of smaller sample sizes, did not specifically describe the statistical power, sample size, or margin of equivalence that the trial was designed to target.
The definition of cUTI varied across the four trials including these patients.
Reviews for Levofloxacin
The studies of cUTI published by Klimberg et al and Richard et al required that all subjects possess an anatomic or functional abnormality of the urinary tract and at least one of the following symptoms: urgency frequency, dysuria, hematuria, or fever or history of fever Klimberg et al ; Richard et al a.
Four trials included AP patients. Similar to the definition of cUTI, Peterson et al required that subjects with AP have at least one of the following symptoms: urgency frequency, dysuria, hematuria, or fever or history of fever Peterson et al In contrast, Peng required only a diagnosis of AP Peng All trials assessed the outcomes of microbiologic eradication and clinical success.
These definitions were similar across all trials Table 1.
Levofloxacin in uti ppt to pdf
In each of the six trials, another fluoroquinolone was selected as the comparator treatment ciprofloxacin in three trials, lomefloxacin in two trials, and ofloxacin in one trial. One trial allowed patients to be administered either oral or intravenous formulations.
The five remaining trials evaluated oral administration of levofloxacin. Four of these trials excluded subjects with previous infections with organisms known to be resistant to any study medication Klimberg et al ; Richard et al a , b. The fifth excluded subjects if the UTI was caused by a pathogen resistant to either study medication Peterson et al Four trials also excluded patients with decreased renal function. Peng excluded patients with renal failure and other extremely severe underlying diseases Peng In both publications, no data were provided as to the number of patients receiving altered dosing, nor were the efficacy and safety results reported within this subset of subjects.
Microbiologic eradication rates for levofloxacin were high in all trials.
When assessed after the completion of therapy, eradication rates ranging from These rates were not statistically significantly different from that of the comparator treatments. The difference was not statistically significant Richard et al b.
All publications provided information regarding the uropathogens that were most frequently isolated, and in all E. Other commonly isolated pathogens included K.
While not all studies reported the frequency with which these organisms were isolated, among those that did, K. In their cUTI trial, Richard et al a reported that 9. These were the only publications to provide these data.
A Review of Levofloxacin for the Treatment of Bacterial Infections
As may be expected, the usage of urinary catheters was observed in a number of patients in the included trials. Only one of the trials reported outcomes based on catheter usage. Peterson et al reported a significantly worse microbiologic eradication in the 68 catheterized patients compared to those without catheters