Levofloxacin for the Treatment of Urosepsis
Ercole Concia, MDa
Anna Maria Azzini, MDb
aChief of the Infectious Disease Unit,"G.B. Rossi" Hospital
Professor of Infectious Diseases, University of Verona, Verona, Italy
bInfectious Disease Unit, "G.B. Rossi" Hospital
University of Verona, Verona, Italy
Urosepsis accounts for approximately 20-30% of all patients with sepsis and frequently arises from complicated urinary tract infections (UTIs). The bacterial spectrum in urosepsis is above all represented by Gram-negative rods, such as Escherichia coli (50%), Proteus spp. (15%), Enterobacter and Klebsiella spp. (15%), and Pseudomonas aeruginosa (5%), although Gram-positive organisms can also be involved, but less frequently (15%). The distribution of antibiotic resistance rates has not been specifically described for urosepsis but only for UTIs in general, and it is reasonable to believe that the pathogens and related resistance patterns are similar. One of the most important questions about community-acquired uropathogens, particularly E. coli, is the increasing level of co-trimoxazole (CTX) resistance. While the resistance of E. coli and other Gram-negative pathogens to CTX has risen markedly over the past decade, quinolones have continued to exhibit good activity against these organisms, even although there have also been recent reports about increasing levels of resistance to these drugs.
Injectable antibiotics, such as fluoroquinolones and piperacillin/tazobactam, are recommended in the treatment of urosepsis (26). Levofloxacin has double the renal excretion rate of ciprofloxacin and this make it an ideal agent for UTIs together with the advantage that it can be administered as sequential therapy, being available in an intravenous and oral form. Despite these characteristics, few clinical trials have been performed to define its role in urosepsis.