Safety of Prolonged High-Dose Levofloxacin Therapy for Bone Infections

Abstract

The records of 84 patients with bone infections treated with high-dose levofloxacin (i.e. 0.75-1g daily) for more than 4 weeks were reviewed. Patients were given either 500 mg b.i.d. throughout the treatment period [Group 1 (n=41)], 500 mg b.i.d. for 3 weeks and then 750 mg q.d. [Group 2 (n=21)] or 750 mg q.d. for the whole treatment period [Group 3 (n=22)]. All patients had combined therapy, including levofloxacin-rifampin in 62 cases (73.8%), for an average duration of 13.7 weeks. Muscular pain and/or tendonitis were reported in 19 patients (22.6%) which affected more patients in Groups 1 and 2 than in Group 3 (14/41 and 5/21 vs. 0/22; p=0.01 and 0.001, respectively). A dosage of 750 mg q.d. may be warranted for prolonged high-dose levofloxacin treatment in patients with bone infections rather than 500 mg b.i.d. for the entire duration of treatment, or for the first 3 weeks.

Pharmacokinetic and dynamic study of levofloxacin and rifampicin in bone and joint infections

“…Published data on high levofloxacin doses show that they are rather well tolerated [33], even though for courses superior to 4 weeks with a dose of more than 750 mg/d, there were more adverse events (22%), the average onset of adverse events was 40 days [21]. It is interesting to note that in our study on a limited number of patients, we did not find any correlation between high levofloxacin doses and the occurrence of adverse effects.…”

“…The ofloxacin dose per intake needs to be increased to obtain plasma levels of ofloxacin identical to those of levofloxacin in healthy volunteers; this cannot always be achieved because of a safety issue [6,16,17,20]. Furthermore, even if only a few studies have been published on the use of levofloxacin for bone and joint infections, they all concluded to its good effectiveness [7,[21][22][23][24]. Some teams suggested using levofloxacin and not ofloxacin as antibiotherapy for staphylococcal bone and joint infections [2,25].…”

Safety of antibiotics combinations against Staphylococcal bone and joint infections

“…Rifampicin [4][5][6][7], clindamycin [8] and fluoroquinolones [9,10] have already been studied in Staphylococcal BJI, but our study is the first to compare 3 ATB-As in this indication. One third of the AE were recorded during ambulatory care, underlying the importance of a regular follow-up by specialists.…”

Strategies for Treating Latent Multiple-Drug Resistant Tuberculosis: A Decision Analysis

“…Under this assumption, data on the tolerability of pyrazinamide/ethambutol and moxifloxacin/pyrazinamide was taken directly from available literature [4]–[7], [27]. Data suggest that there is little additional toxicity when fluoroquinolones are given as part of a larger TB treatment regimen [19], [34] and fluoroquinolone monotherapy appears to be relatively well-tolerated [35], so we assumed that moxifloxacin monotherapy has a toxicity profile similar to isoniazid. No data for tolerability of moxifloxacin/ethambutol or moxifloxacin/ethionamide exist, so we used toxicity rates published for ethambutol and ethionamide in active MDR-TB to estimate their additional toxicity [19].…”