LEVOFLOXACIN - ITS USE IN INFECTIONS OF THE RESPIRATORY-TRACT, SKIN, SOFT-TISSUES AND URINARY-TRACT

Levofloxacin, the optically pure levorotatory isomer of ofloxacin, is a fluoroquinolone antibacterial agent. Like other fluoroquinolones, it acts on bacterial topoisomerase and has activity against a broad rang e of Gram-positive and Gramnegative organisms. Levofloxacin also appea rs to have improved activity against Streptococcus pneumoniae compared with ciprofloxacin or ofloxacin. Levofloxacin distributes well and ac hieves high levels in excess of plasma concentrations in many tissues (e.g. lung, skin, prostrate). High oral bioavailability allows switchi ng from intravenous to oral therapy without dosage adjustment. In pati ents with mild to severe community-acquired pneumonia receiving treatm ent for 7 to 14 days, oral levofloxacin was similar in efficacy to amo xicillin/ clavulanic acid, and intravenous and/or oral levofloxacin wa s superior to intravenous ceftriaxone and/or oral cefuroxime axetil. W ith levofloxacin use, clinical success (clinical cure or improvement) rates were 87 to 96% and bacteriological eradication rates were 87 to 100%. In the 5- to 10-day treatment of acute exacerbations of chronic bronchitis, oral levofloxacin was similar in efficacy to oral cefuroxi me axetil or cefaclor, Levofloxacin resulted in clinical success in 78 to 94.6% of patients and bacteriological eradication in 77 to 97%. Or al levofloxacin was also similar in efficacy to amoxicillin/clavulanic acid or oral clarithromycin in patients with acute maxillary sinusiti s treated for 7 to 14 days. Equivalence between 7- to 10-day therapy w ith oral levofloxacin and ciprofloxacin was seen in patients with unco mplicated skin and soft tissue infections. Clinical success was seen i n 97.8 and 96.1% of levofloxacin recipients and bacteriological eradic ation in 97.5 and 93.2%. Complicated urinary tract infections, includi ng pyelonephritis, responded similarly well to oral levofloxacin or ci profloxacin for 10 days or lomefloxncin for 14 days. Clinical success and bacteriological eradication rates with levofloxacin occurred in 92 to 93.3% and 93.6 to 94.7% of patients. Conclusions: Levofloxacin can be administered in a once-daily regimen as an alternative to other fl uoroquinolones in the treatment of infections of the urinary tract, sk in and soft tissues. Its more interesting use is as nn alternative to established treatments of respiratory tract infections. S. pneumoniae appears to more susceptible to levofloxacin than to ciprofloxacin or o floxacin. Other newer fluoroquinolone agents that also have enhanced i n vitro, antipneumococcal activity may not share the well established tolerability profile of levofloxacin, which also appears to improve on that of some older fluoroquinolones.