According to the IDSA guidelines, what is the role of fluoroquinolones? Could you also compare the use of levofloxacin with that of ciprofloxacin?

20 June, 2018

Q16. According to the IDSA guidelines, what is the role of fluoroquinolones? Could you also compare the use of levofloxacin with that of ciprofloxacin?

Summary: The 2010 IDSA guidelines recommend using empiric fluoroquinolones when treating low-risk febrile neutropenic patients. When developing the guidelines it was found that the most commonly studied fluoroquinolone in this situation was ciprofloxacin, administered in combination with amoxicillin-clavulanate. Due to ciprofloxacin’s lack of activity against Gram-positive bacteria, monotherapy with ciprofloxacin was not recommended. However, levofloxacin, which does have both Gram-positive and Gram-negative coverage has the potential to be given as monotherapy in low-risk febrile neutropenic patients. The guidelines also note that fluoroquinolones can be used in high-risk patients who have started to recover following administration of parenteral broad-spectrum antibiotics. In these patients, treatment can be switched to the orally administered fluoroquinolone if the culture confirms susceptibility to these agents.