Infection
Update

Quinolones News

#6 May 2, 2017

Short-course, high-dose levofloxacin provides advantages over conventional treatment for complicated urologic infections.

Urinary tract infections (UTIs) exert a significant health impact globally, with fluoroquinolones the drug of choice for treatment of complicated UTIs. However concern has been raised about the increase in ciprofloxacin resistant E. coli, prompting the need for more effective regimens. One proposed therapy is short course high dose levofloxacin. 

A large Chinese prospective, randomized, controlled clinical trial investigated levofloxacin 750mg/day for 5 days vs. levofloxacin 500mg/day for 7-14 days in complicated UTIs (cUTIs) and acute pyelonephritis (APN). Analysis confirmed an 89.87% clinical success rate in the short-course regimen (142/158), compared to 89.31% for the longer duration (142/159). Microbiological eradication rates were also similar (short-course therapy: 89.55%, 60/67; conventional therapy: 86.30%, 63/73; p > 0.05) and there were no significant differences in other parameters, including recurrence rates. Incidence of drug-related adverse effects was similar (18.9% vs. 15.7%, for short and long-course therapy, respectively). It was also shown that the effectiveness of each regimen continued for at least 7 days after discontinuation and that this effect was more obvious for the high-dose therapy.

The total duration of the levofloxacin 750 mg regimen was 50% shorter and the total dose 27% less than the conventional regimen, strongly indicating that the high-dose regimen is likely to be associated with reduced costs, an important consideration in countries with large populations and limited medical resources.

Researchers concluded that patients with cUTIs and APN treated with short-course levofloxacin therapy had similar outcomes to longer duration therapy in terms of clinical and microbiological efficacy, tolerance, and safety. This convenient alternative has more potential advantages in terms of anti-resistance and cost saving as well.

PMID: 28108978

Int Urol Nephrol. 2017 Mar;49(3):499-507. doi: 10.1007/s11255-017-1507-0.

Source : https://www.ncbi.nlm.nih.gov/pub med/28108978?dopt=Abstract

 
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