Fluoroquinolones like levofloxacin are used widely for treating many infections, including those of bone and joint tissue (BJI). To clarify the role of levofloxacin in this setting, French researchers performed a retrospective cohort analysis assessing the benefit-risk ratio of standard-dose levofloxacin compared to non-levofloxacin containing regimens. Diagnosis was made using tissue culture, with 500mg once daily oral levofloxacin prescribed as part of a combination regimen for 3 months.
Data from patients admitted with BJI were reviewed, with outcome assessed at the end of antibiotic treatment as well as one year later. Outcome was defined as improvement (cure + functional recovery), partial improvement (cure + functional loss), not cured (persistence /relapse of infection), or death.
230 BJI patients were included in the analysis; 79 (34%) were treated with a levofloxacin-containing regimen. Of the 79 levofloxacin-treated cases, 5 received a different dose (4 with 750mg due to obesity and one 250mg due to renal failure). Identification of pathogens revealed that more of the levofloxacin-treated patients had an infection caused by methicillin-susceptible Staphylococcus aureus (MSSA).
Clinical outcome was similar for both groups, with levofloxacin-treated patients having a favourable outcome (total or partial recovery) in 89-93% of that group. However, there was a marked difference in duration of therapy, with levofloxacin-treated patients having a median 13 weeks of treatment, compared with other antibiotic regimens, with a mean of 6 weeks.
Results of the cohort analysis confirmed that 500 mg of levofloxacin once daily provides an effective and well tolerated treatment for patients requiring treatment of bone and joint infections. Researchers noted that the excellent cortical bone diffusion and clinical outcomes achieved support the use of levofloxacin in BJI.
Int J Antimicrob Agents. 2016 Jun;47(6):478-81. doi: 10.1016/j.ijantimicag.2016.03.003.