Optimal Management of RTI – Intriguing New Results in ABECOPD in Asia

29 March, 2018

Question 7

Could you compare levofloxacin with other respiratory tract antimicrobials?

Levofloxacin possesses many advantages when treating RTI. It achieves very good tissue and lung concentrations as well as being very effective against Gram-positive organisms such as S. pneumoniae and other streptococci. In addition, levofloxacin possesses good coverage against Gram-negatives including Haemophilus influenzae, Moraxella catarrhalis and enteric Gram-negatives such as Klebsiella pneumoniae which can be a major problem in patients with chronic obstructive pulmonary disease (COPD), bronchiectasis or immunosuppression.
In contrast, other antimicrobials, such as gatifloxacin and trovafloxacin, which cover the same pathogens, have encountered tolerability issues. Another competitor, moxifloxacin that also possesses good Gram-positive activity has much less Gram-negative activity. This means that if physicians choose to prescribe moxifloxacin, they need to be sure that the infection is due to a Gram-positive pathogen and not an enteric Gram-negative at the time of initial presentation. As we are aware, in most instances physicians need to start treatment empirically before knowing the identity of the causative pathogen. Therefore, using levofloxacin provides additional coverage and associated peace of mind in this situation.