Question 24

Do you think levofloxacin is a better choice than moxifloxacin when treating ABECOPD in countries with higher prevalence rates of P. aeruginosa infection?

I think so. Levofloxacin has a good track record against Pseudomonas spp., although there has been a drop in activity in tandem with ciprofloxacin. In my institution, we are probably looking at 60% to 65% coverage with levofloxacin but with levofloxacin achieving much higher serum and lung concentrations than ciprofloxacin, there is a good chance that levofloxacin will be effective when treating this pathogen. In contrast, moxifloxacin does not have breakpoints for Pseudomonas spp., so laboratories cannot assess susceptibility. If using levofloxacin in this situation, it is important to test and verify that the organism is susceptible.