Question 11

You mention possible differences based on body mass, does this have an effect when treating Asian people, who tend to be smaller?

This is an interesting issue but there are no clear data to answer this. Initially, in Japan, some clinicians used a lower dose of levofloxacin three times daily. However, we now know that PK data supports the use of once-daily therapy with either 500 mg or 750 mg doses. It is also clear that compliance is much higher when using a once-daily regimen and this, coupled with the higher peak concentration and higher area under the AUC, is associated with greater bacterial kill. There may be some situations where patients in Asia are substantially smaller than the average 70 kg American, and in these patients, the 500 mg dose have PK parameters similar to the 750 mg dose, but this is unclear. This is an issue that needs to be investigated and debated at local and regional levels, allowing guidelines to be tailored to local requirements.