Urinary bactericidal activity of single doses (250, 500, 750 and 1000mg) of levofloxacin against fluoroquinolone-resistant strains of Escherichia coli

Stein, Gary E.; Schooley, Sharon; Nicolau, David P.

doi:10.1016/j.ijantimicag.2008.04.025

Cited by 25 publications

(19 citation statements)

References 29 publications

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“…In particular, the C max /MIC thresholds for Gram-positive cocci were <1. Approximately 80% of LVFX is secreted into the urine and in this location the peak concentration reaches 60-to 90-fold the plasma concentration [19]. The antibacterial activity of LVFX in the urine is much reduced, but LVFX in the urine maintains bactericidal activity against uropathogens [14,20].…”

Section: Discussionmentioning

confidence: 99%

Microbiological outcome of complicated urinary tract infections treated with levofloxacin: a pharmacokinetic/pharmacodynamic analysis

Deguchi

Nakane

Yasuda

et al. 2010

International Journal of Antimicrobial Agents

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Section: Discussionmentioning

confidence: 99%

Microbiological outcome of complicated urinary tract infections treated with levofloxacin: a pharmacokinetic/pharmacodynamic analysis

Deguchi

Nakane

Yasuda

et al. 2010

International Journal of Antimicrobial Agents

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“…High-dose fluoroquinolones such as levofloxacin might be successful in treatment of mild UTI with fluoroquinolone-resistant, Gram-negative uropathogen. 58 Finally, fluoroquinolones should not be used as empiric treatment of cUTIs in patients with recent use of fluoroquinolones, recurrent UTIs, and recent hospitalization due to the emergence of fluoroquinoloneresistant uropathogens. 59 Traditionally, an aminoglycoside alone or in combination with a β-lactam has been considered a first-line option for the management of cUTIs.…”

Section: Management Of Complicated Urinary Tract Infectionsmentioning

confidence: 99%

Management of Complicated Urinary Tract Infections in the Era of Antimicrobial Resistance

Bader

Hawboldt

Brooks

2010

Postgraduate Medicine

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Complicated urinary tract infections (cUTIs) are a major cause of hospital admissions and are associated with significant morbidity and health care costs. Patients presenting with a suspected UTI should be screened for the presence of complicating factors, such as anatomic and functional abnormalities of the genitourinary tract. In the setting of cUTIs, the etiology and susceptibility of the causative organism is not predictable; therefore, when infection is suspected, patients should undergo a urinalysis in addition to culture and sensitivity testing. Although not warranted in all cases of complicated pyelonephritis, blood cultures are appropriate in some clinical settings. With the increased prevalence of antimicrobial resistance, and the lack of well-designed clinical trials, treatment of cUTIs can be challenging for clinicians. Although resistant organisms are not always implicated as the causative agent, all patients with cUTIs should be assessed for predisposing risk factors. Consideration of an optimal antimicrobial agent should be based on local resistance patterns, patient-specific factors, including anatomic site of infection and severity of disease, pharmacokinetic and pharmacodynamic principles, and cost. Resistance to first-line antimicrobial agents, including fluoroquinolones, has become increasingly common in Escherichia coli. Fluoroquinolones should not be used as a first-line option for empiric treatment of serious cUTIs, especially when patients exhibit risk factors for harboring a resistant organism, such as previous or recent use of fluoroquinolones. Fluoroquinolones, trimethoprim-sulfamethoxazole, and nitrofurantoin are still appropriate empiric options for mild lower cUTIs. However, empiric treatment for serious cUTIs, where risk factors for resistant organisms exist, should include broad-spectrum antibiotics such as carbapenems or piperacillin-tazobactam. Once organisms and susceptibilities are identified, treatment should be targeted accordingly. Nitrofurantoin and fosfomycin have limited utility in the setting of cUTIs and should be reserved as alternative treatment options for lower cUTIs following confirmation of the causative organism. Aminoglycosides, tigecycline, and polymyxins can be used for the treatment of serious cUTIs when first-line options are deemed to be inappropriate or patients fail therapy. The duration of treatment for cUTIs has not been well established; however, treatment durations can range from 1 to 4 weeks based on the clinical situation.

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“…15 Previous studies also found that ciprofloxacin at standard doses or ciprofloxacin XR (1,000 mg) once daily had prolonged bactericidal activity in urine. 18 Some reported clinical cases support those ex vivo findings.…”

mentioning

confidence: 94%

Consensus statement on the role of fluoroquinolones in the management of urinary tract infections

Hsueh

Lau

et al. 2011

Journal of Microbiology, Immunology and Infection

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A consensus meeting was held aimed at attaining a consensus on the role of fluoroquinolones in the management of complicated urinary tract infections (cUTI), particularly in countries with high rates (>20%) of fluoroquinolone-resistant uropathogens. Pharmacokinetic/pharmacodynamic and limited clinical data support the fact that specific fluoroquinolone breakpoints might be needed for UTI. Resistant isolates causing mild to moderate cUTI with relatively low minimum inhibitory concentrations (MICs 16e32 mg/mL) might clinically respond to fluoroquinolone therapy. (P.-R. Hsueh).a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e -j m i i . c o m

show abstract

Urinary bactericidal activity of single doses (250, 500, 750 and 1000mg) of levofloxacin against fluoroquinolone-resistant strains of Escherichia coli

Cited by 25 publications

References 29 publications

Microbiological outcome of complicated urinary tract infections treated with levofloxacin: a pharmacokinetic/pharmacodynamic analysis

Microbiological outcome of complicated urinary tract infections treated with levofloxacin: a pharmacokinetic/pharmacodynamic analysis

Management of Complicated Urinary Tract Infections in the Era of Antimicrobial Resistance

Consensus statement on the role of fluoroquinolones in the management of urinary tract infections

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