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Clinical Utilities 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).

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Last updated February 13, 2001.