of Sequential Therapy (Step-Down from Intravenous to Oral) with Levofloxacin for
Hospitalized Patients with Lower Respiratory Tract Infections
S. Ragnar Norrby, MD, PhD, FRCP (Edin)
Department of Infectious Diseases and Medical Microbiology, University of Lund,
Lund University Hospital, Lund, Sweden
Levofloxacin was developed from ofloxacin and has markedly improved
activity against Gram-positive bacteria, including penicillin-resistant
pneumococci. It is available for both oral (PO) and intravenous
(IV) administration, and after oral intake the bioavailability is
close to 100%. This makes levofloxacin particularly suitable for
step-down therapy where the patient is started on an IV regimen
and when there is an improvement, therapy is subsequently switched
to the PO route. In turn, this enables earlier discharge from hospital
and less need for costly intensive home care as with ceftriaxone.
Levofloxacin has a very well documented safety profile which, compared
to other new fluoroquinolones, is very favorable. Thus, levofloxacin
causes few, if any, phototoxic reactions, the potential for central
nervous system (CNS) side effects is low and it does not interact
with warfarin or theophylline.
Levofloxacin has been demonstrated to be significantly more effective
than PO cephalosporins for the treatment of acute exacerbations
of chronic bronchitis (AECB). In community-acquired pneumonia (CAP),
levofloxacin has been shown to be as effective as ceftriaxone, or
ceftriaxone followed by cefuroxime axetil. In one prospective randomized
study using a critical pathway approach, levofloxacin monotherapy
was found to be as effective and more economical than standard therapy.
There is still a need for more prospective studies on the pharmacoeconomic
consequences and possible benefits of the use of levofloxacin.
In conclusion, levofloxacin offers a safe, effective and very well
documented alternative to other antibiotics for the treatment of
lower respiratory tract infections (LRTIs).