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Research in Veterinary Science Jul 2021A potent third-generation antimicrobial fluoroquinolone drug, levofloxacin was introduced into human clinical practice in 1993. Levofloxacin is also used in veterinary... (Review)
Review
A potent third-generation antimicrobial fluoroquinolone drug, levofloxacin was introduced into human clinical practice in 1993. Levofloxacin is also used in veterinary medicine, however its use is limited: it is completely banned for veterinary use in the EU, and used extralabel in only companion animals in the USA. Since its introduction to clinical practice, many studies have been published on levofloxacin in animal species, including pharmacokinetic studies, tissue drug depletion, efficacy, and animal microbial isolate susceptibility to levofloxacin. This literature overview highlights the most clinically relevant and scientifically important levofloxacin studies linked to the field of veterinary medicine.
Topics: Animals; Anti-Infective Agents; Humans; Levofloxacin
PubMed: 33964616
DOI: 10.1016/j.rvsc.2021.04.031 -
American Journal of Therapeutics
Topics: Humans; Levofloxacin; Anti-Bacterial Agents; Ofloxacin; Brain Diseases
PubMed: 36848632
DOI: 10.1097/MJT.0000000000001615 -
Expert Opinion on Pharmacotherapy Jun 2013Levofloxacin , the l-isomer of ofloxacin has become one of the cornerstones of antibiotic therapy of pyelonephritis since its introduction in the 1990s, thanks to its... (Review)
Review
INTRODUCTION
Levofloxacin , the l-isomer of ofloxacin has become one of the cornerstones of antibiotic therapy of pyelonephritis since its introduction in the 1990s, thanks to its exceptional pharmacokinetic (PK) and pharmacodynamic (PD) profile, broad-spectrum antibacterial action and satisfactory tolerance. However, the emergence of widespread fluoroquinolone resistance over the past decade, has prompted to re-examine its place in the treatment of urinary tract infection.
AREAS COVERED
This review covers the medical literature in any language through December 2012, on 'levofloxacin'. To identify relevant articles, the search terms 'pyelonephritis', 'urinary tract infections', 'levofloxacin', 'levaquin' and 'ofloxacin' were obtained through PubMed, MEDLINE and Clinicaltrials.gov queries. The authors focus on clinical trials, articles related to the PK and PD properties of levofloxacin as well as recent development in the mechanisms and prevalence of levofloxacin resistance. Major points stemming from international guidelines are also reviewed.
EXPERT OPINION
Levofloxacin has achieved satisfactory bacterial eradication rates and clinical success across all available trials, similar to the antibiotic comparator. High-dose (750 mg) orally administrated levofloxacin over a short 5-day course is a reasonable option for patients eligible for outpatient management. Levofloxacin is no longer a suitable option for first-line empirical treatment of pyelonephritis in areas where resistance rates are high (> 10%) when pyelonephritis is hospital-acquired. Efforts to promote fluoroquinolone-sparing agents should be encouraged and its prescription should be performed in compliance with antimicrobial guidelines.
Topics: Administration, Oral; Ambulatory Care; Anti-Bacterial Agents; Drug Resistance, Bacterial; Humans; Levofloxacin; Practice Guidelines as Topic; Pyelonephritis; Urinary Tract Infections
PubMed: 23614756
DOI: 10.1517/14656566.2013.792805 -
Pharmacoepidemiology and Drug Safety May 2014Standard triple therapy for Helicobacter pylori infection fails in up to one quarter of patients. Levofloxacin-based triple therapy may be more efficacious. (Comparative Study)
Comparative Study Review
BACKGROUND
Standard triple therapy for Helicobacter pylori infection fails in up to one quarter of patients. Levofloxacin-based triple therapy may be more efficacious.
OBJECTIVE
The aim of this paper was to compare levofloxacin and proton pump inhibitor-based triple therapy with standard triple therapy for H. pylori infection.
METHODS
PubMed, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Google Scholar, and Ovid were systematically searched to identify randomized controlled trials comparing levofloxacin and proton pump inhibitor-based therapy with standard triple therapy in treatment-naive patients with H. pylori infection until August 2013.
RESULTS
Ten randomized controlled trials involving 2676 patients (1357 in the levofloxacin group and 1319 in the control group) met the inclusion criteria. The pooled odds ratio by intention-to-treat analysis and by per protocol analysis in the levofloxacin regimen versus standard regimen was 1.28 [95% confidence interval (CI): 0.88-1.85] and 1.23 (95% CI: 0.82-1.84) by the random effects model, respectively. There was no statistical significance of the incidence of total side effects between the groups, but levofloxacin-based therapy was associated with a significant reduction in the incidence of taste disturbance compared with standard third therapy.
CONCLUSION
Levofloxacin-based therapy was as safe and effective as triple therapy for H. pylori infection and could be considered as an additional treatment option. However, more rigorous research is required to accurately assess the role of levofloxacin in eradicating H. pylori infection.
Topics: Anti-Bacterial Agents; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Levofloxacin; Proton Pump Inhibitors
PubMed: 24677603
DOI: 10.1002/pds.3581 -
American Journal of Therapeutics Mar 2020
Topics: Anti-Bacterial Agents; Humans; Levofloxacin; Mania; Ofloxacin
PubMed: 32195669
DOI: 10.1097/MJT.0000000000001161 -
Internal Medicine (Tokyo, Japan) May 2019A 64-year-old woman with no previous mental illness took a single 500 mg tablet of levofloxacin for cystitis. Two hours later, she developed psychosis with involuntary...
A 64-year-old woman with no previous mental illness took a single 500 mg tablet of levofloxacin for cystitis. Two hours later, she developed psychosis with involuntary movement and severe hyperventilation with respiratory alkalosis. Cranial magnetic resonance imaging findings were unremarkable, and an electroencephalogram revealed no epileptiform discharge. Her symptoms improved on the third day after levofloxacin was discontinued. Levofloxacin-associated encephalopathy with psychotic features is a rare adverse event. Disturbance of gamma-aminobutyric acid-ergic (GABAergic) interneurons by levofloxacin may lead to hyperventilation via dysfunction of the brainstem respiratory network. Physicians should be aware of hyperventilation as an additional serious symptom of levofloxacin-associated encephalopathy in acute settings.
Topics: Anti-Infective Agents, Urinary; Brain Diseases; Cystitis; Female; Humans; Hyperventilation; Levofloxacin; Middle Aged; Treatment Outcome
PubMed: 30713304
DOI: 10.2169/internalmedicine.1619-18 -
The Journal of Antimicrobial... Oct 2016The emergence of MDR-TB and XDR-TB has complicated TB treatment success. Among many factors that contribute to the development of resistance, low drug exposure is not... (Review)
Review
The emergence of MDR-TB and XDR-TB has complicated TB treatment success. Among many factors that contribute to the development of resistance, low drug exposure is not the least important. This review summarizes the available information on pharmacokinetic properties of levofloxacin in relation to microbial susceptibilities, in order to optimize the dose and make general treatment recommendations. A total of 37 studies on adult (32 studies) and paediatric (5 studies) MDR-TB patients were included. Among the 32 adult studies, 19 were on susceptibility of Mycobacterium tuberculosis isolates to levofloxacin by MIC, 1 was on susceptibility of M. tuberculosis isolates to levofloxacin by MBC, 1 was on susceptibility of M. tuberculosis isolates to levofloxacin by mutant prevention concentration and 4 were on pharmacokinetics of levofloxacin, and 7 others were included. Likewise, out of five studies on children, two dealt with levofloxacin pharmacokinetic parameters, one reviewed CSF concentrations and two dealt with background information. In adult MDR-TB patients, standard dosing of once-daily 1000 mg levofloxacin in TB treatment did not consistently attain the target concentration (i.e. fAUC/MIC >100 and fAUC/MBC >100) in 80% of the patients with MIC and MBC of 1 mg/L, leaving them at risk of developing drug resistance. However, with an MIC of 0.5 mg/L, 100% of the patients achieved the target concentration. Similarly, paediatric patients failed consistently in achieving given pharmacokinetic/pharmacodynamic targets due to age-related differences, demanding a shift towards once daily dosing of 15-20 mg/kg. Therefore, we recommend therapeutic drug monitoring for patients with strains having MICs of ≥0.5 mg/L and suggest revising the cut-off value from 2 to 1 mg/L.
Topics: Adult; Anti-Bacterial Agents; Antitubercular Agents; Child; Clinical Trials as Topic; Extensively Drug-Resistant Tuberculosis; Humans; Levofloxacin; Microbial Sensitivity Tests; Mycobacterium tuberculosis; Treatment Outcome; Tuberculosis, Multidrug-Resistant
PubMed: 27231277
DOI: 10.1093/jac/dkw164 -
Scandinavian Journal of Gastroenterology May 2014To evaluate the available data on the efficacy and safety of levofloxacin-based triple therapy compared with standard triple therapy in first-line treatment for... (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVES
To evaluate the available data on the efficacy and safety of levofloxacin-based triple therapy compared with standard triple therapy in first-line treatment for Helicobacter pylori infection.
METHODS
By searching MEDLINE, The Cochrane Central Register of Controlled Trials, and Web of Knowledge, two independent reviewers systemically identified randomized controlled trials comparing levofloxacin-based triple regimen with standard triple therapy for first-line treatment of H. pylori infection. The pooled risk ratios (RR) and 95% confidence intervals were calculated.
RESULTS
Overall, nine randomized controlled trials including 1275 patients have been treated with levofloxacin-based triple therapy and 1237 patients with standard regimen. Eradication rate in the levofloxacin-based therapy group was slightly higher than that in the standard triple therapy group regardless of treatment duration (80.2% vs. 77.4%, RR=1.03, 95% CI=0.94-1.13). Subgroup analysis related to different geographic areas found that efficacy of 7-day standard triple regimen was statistically superior to 7-day levofloxacin-based scheme in Asian group (RR=0.91, 95% CI=0.86-0.97), but levofloxacin-based triple therapy was predominant regardless of treatment time in European countries (RR=1.15, 95% CI=1.06-1.23). There was no significant difference between two groups in the incidence of overall adverse events or in the occurrence of discontinuing therapy due to side effects.
CONCLUSIONS
The 10-day levofloxacin-based triple therapy may be considered as an alternative for increasing cure rate of H. pylori infection in European areas. But in Asian countries, standard triple regimen is still superior to levofloxacin-based therapy as first-line regimen for H. pylori eradication.
Topics: Anti-Bacterial Agents; Asia; Drug Therapy, Combination; Europe; Helicobacter Infections; Helicobacter pylori; Humans; Levofloxacin; Randomized Controlled Trials as Topic
PubMed: 24611790
DOI: 10.3109/00365521.2014.887765 -
Nephrology (Carlton, Vic.) Jun 2015
Topics: Acute Kidney Injury; Anti-Infective Agents; Biomarkers; Creatinine; Crystallization; Female; Humans; Levofloxacin; Middle Aged; Renal Dialysis; Treatment Outcome
PubMed: 25900386
DOI: 10.1111/nep.12405 -
Future Microbiology Dec 2022Drug repurposing is a viable approach to expediting the tedious conventional drug discovery process, given rapidly increasing bacterial resistance. In this context, we...
Drug repurposing is a viable approach to expediting the tedious conventional drug discovery process, given rapidly increasing bacterial resistance. In this context, we have repurposed pyrvinium pamoate (PP) for its antibacterial activity against . US FDA-approved non-antibiotics were screened against clinically relevant bacterial pathogens to identify antibacterials. The hits were further evaluated utilizing a variety of preclinical parameters, following which efficacy was estimated in isolation and in combination in a murine neutropenic thigh infection model. The screening identified PP exhibiting potent activity against along with concentration-dependent killing. PP also showed a post-antibiotic effect of >22 h and significantly eradicated preformed biofilms and intracellular at 1× and 5× MIC, respectively. PP synergized with levofloxacin both and , resulting in ∼1.5 and ∼0.5 log CFU/g reduction against susceptible and resistant infections, respectively, as compared with untreated control. Pyrvinium potentiates levofloxacin against levofloxacin-resistant
Topics: Mice; Animals; Levofloxacin; Staphylococcus aureus; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Staphylococcal Infections; Anti-Bacterial Agents
PubMed: 36314364
DOI: 10.2217/fmb-2022-0159