Levofloxacin: The optimal choice in treatment for respiratory tract infections

20 July, 2020

Associate Professor Lê Tiến Dũng

Head of Respiratory Department, University Medical Center

Ho Chi Minh City, Vietnam

The 750 mg, 5-day levofloxacin regimen has been shown to achieve efficacy and safety outcomes that are comparable to the conventional 500 mg, 10-day regimen for the treatment of mild-to-severe-community-acquired pneumonia (CAP).^1-3

The American Thoracic Society and Infectious Diseases Society of America (IDSA) recommend monotherapy of high-dose, short-course levofloxacin for the treatment of CAP in patients with comorbidities such as chronic heart, lung, liver, or renal disease and diabetes mellitus as well as those with non-severe CAP without risk factors for methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa.⁴

Associate Professor Dr Lê Tiến Dũng, Head of the Respiratory Department at the University Medical Center of Ho Chi Minh City, explains the benefits of high-dose, short-course levofloxacin for the treatment of respiratory tract infections.

Q1. Please describe the aetiology and epidemiology profile of respiratory tract infections in Vietnam.

In Vietnam, Streptococcus pneumoniae accounts for 30% of CAP; penicillin-resistant S. pneumoniae (PRSP) is a particular concern in our country with over 60% observed amongst patients with CAP. Other common causative pathogens include Haemophilus influenzae, and Moraxella catarrhalis. Gram-negative bacteria such as Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa are also observed in 5% to 15% of cases while Staphylococcus aureus accounts for approximately 6% of CAP.

Q2. What are the common indications of high-dose, short-course levofloxacin in Vietnam? What are your considerations when prescribing this regimen for patients with respiratory tract infections?

High-dose, short-course levofloxacin is commonly indicated for mild or moderate CAP and moderate exacerbation of chronic obstructive pulmonary disease (COPD) in Vietnam. I am confident in prescribing this regimen for my patients with respiratory tract infections because levofloxacin has good antibacterial activity and is active against both Gram-positive and Gram-negative bacteria, including PRSP.

Q3. What is the role of levofloxacin for empirical treatment of respiratory tract infections in Vietnam? What are the advantages of using high-dose, short-course levofloxacin – particularly for the treatment of respiratory tract infections?

Clinicians here typically use respiratory quinolone such as levofloxacin for the empirical treatment of respiratory tract infections caused by PRSP. In addition, the emergence of resistant bacteria is also a challenge for effective treatment with beta-lactam antibiotics. Thus, levofloxacin is often the treatment of choice.

In our experience, the high-dose, short-course levofloxacin has been effective for the treatment of respiratory tract infections. The short duration of treatment is also an advantage in using this regimen.

Q4. In your experience, are there any differences in using high-dose, short-course levofloxacin compared with a conventional dosing regimen?

As mentioned, Vietnam has a high incidence of PRSP CAP. As such, we only use the high-dose, short-course levofloxacin treatment i.e., 750 mg for 5 to 7 days. We do not use the conventional dosing of 500 mg for 10 days.

Q5. How is the high-dose, short-course levofloxacin therapy beneficial for CAP patients with comorbidities and those with non-severe CAP?

This regimen has also been effective for our patients with comorbidities and those with non-severe CAP (in addition to patients with mild or moderate CAP and moderate exacerbation of COPD). The regimen not only has a broad coverage of pathogens, but also treatment duration is relatively shorter, thus convenient for our patients. The shorter treatment duration also presents a great advantage in reducing the development of mutation-mediated antibiotic resistance.