Levofloxacin for the Treatment of Respiratory Tract Infections Based on Treatment Guidelines
Chi-Huei Chiang, MD
Division of Pulmonary Immunology and Infectious Diseases, Chest Department, Taipei Veterans General Hospital, Department of Medicine, National Yang-Ming University, Taipei, Taiwan
Due to the persistent and continuous increase of antimicrobial resistance, therapeutic strategies should be aimed at decreasing the emergence of resistant strains and ensuring clinical efficacy. Treatment of respiratory tract infections (RTIs) is, for the most part empirical, therefore any antibiotic treatment should cover both typical and atypical pathogens.
Most guidelines recommend levofloxacin for the treatment of outpatients with community-acquired pneumonia (CAP), who have comorbidities or recent antibiotic exposure. Evidence from clinical trials of levofloxacin indicates that fluoroquinolone monotherapy provides clinical efficacy for hospitalized CAP patients and supports the use of high-dose levofloxacin (750 mg) for nosocomial pneumonia. Because of its excellent penetration, favorable pharmacodynamic profile and, unlike aminoglycosides, lower nephrotoxicity, current American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) guidelines for the treatment of hospital-acquired pneumonia (HAP) recommend levofloxacin for early- and lateonset HAP. The Canadian Thoracic Society and Canadian Infectious Disease Society guidelines recommend fluoroquinolones as potential first-line therapy for patients with acute exacerbations of chronic bronchitis (AECB) and other risk factors. Levofloxacin is also the preferred oral agent for the treatment of drug-resistant tuberculosis or when first-line agents cannot be used because of intolerance.
Levofloxacin is beneficial because it has low resistance, good activity and high respiratory penetration, and is well tolerated. It can be easily switched from intravenous to oral therapy, and it can be used as short-course, high-dose therapy to help decrease the emergence of resistant strains. Levofloxacin is therefore a promising agent for the first-line treatment of RTIs.