Levofloxacin: A therapeutic review

This therapeutic review discusses the pharmacology, pharmacokinetics, in vi tro activity, drug interactions, and adverse effects of levofloxacin, a flu oroquinolone antibiotic. Particular emphasis is placed on the clinical effi cacy of levofloxacin and its place in therapy. Compared with ciprofloxacin and the earlier quinolone agents, levofloxacin has an improved pharmacokine tic profile that allows convenient once-daily dosing in either an oral or p arenteral formulation. Levofloxacin has enhanced activity against gram-posi tive aerobic organisms, including penicillin-resistant pneumococci. In publ ished comparative trials involving commonly used treatment regimens, levofl oxacin had equivalent if not greater activity in the treatment of community -acquired pneumonia, acute bacterial exacerbations of chronic bronchitis, a cute bacterial sinusitis, acute pyelonephritis, and complicated urinary tra ct infection. Levofloxacin is well tolerated and induces minimal adverse dr ug reactions. Based on the above attributes, it may be reasonable to includ e levofloxacin on the hospital formulary in place of older quinolones. More recently released quinolones such as trovafloxacin exhibit similar advanta ges; however, until direct comparative trials between levofloxacin and thes e newer agents are conducted, it is difficult to advocate one agent over an other. Regardless of which quinolone is the primary agent on the formulary, it is imperative that this class of antimicrobial drugs be used with discr etion to minimize the development of resistance.