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Levofloxacin versus ciprofloxacin versus lomefloxacin in acute pyelonephritis
G A Richard1, I N Klimberg, C L Fowler
1Department of Pediatric Nephrology, University of Florida, Gainesville 32610, USA.
Objectives:
To evaluate, in two randomized, multicenter trials, levofloxacin compared with ciprofloxacin and lomefloxacin for efficacy and safety in treating acute pyelonephritis.
Methods:
We enrolled a total of 186 patients with bacteriologically proved infection. Of these, 89 patients in both trials combined received levofloxacin 250 mg once daily; 58 received ciprofloxacin 500 mg twice daily in the first trial (double blind); and 39 received lomefloxacin 400 mg once daily in the second trial (open label). Microbiologic response of patients evaluable for microbiologic efficacy was the primary efficacy variable, and clinical response of microbiologically evaluable patients was the secondary efficacy variable in both studies.
Results:
Escherichia coli was the most prevalent pathogen. At 5 to 9 days after the end of treatment, 95% of uropathogens were eradicated in patients who received levofloxacin compared with 94% in the ciprofloxacin-treated group and 95% in the lomefloxacin-treated group. The clinical cure rate was 92% for levofloxacin in both studies combined, 88% for ciprofloxacin, and 80% for lomefloxacin. Drug-related adverse events were reported by 2% of levofloxacin-treated patients, 8% of ciprofloxacin-treated patients, and 5% of lomefloxacin-treated patients.
Conclusions:
The once-daily oral administration, proven efficacy, and good tolerability make levofloxacin an excellent choice for empiric treatment of acute pyelonephritis.
Insights
Levofloxacin demonstrated high efficacy and safety for treating acute pyelonephritis, comparable to ciprofloxacin and lomefloxacin. Its once-daily oral dosing offers an excellent option for empiric treatment of this common kidney infection.
Area of Science:
- Infectious Diseases
- Pharmacology
- Urology
Background:
- Acute pyelonephritis is a significant upper urinary tract infection.
- Effective antibiotic treatment is crucial for preventing complications.
Purpose of the Study:
- To compare the efficacy and safety of levofloxacin with ciprofloxacin and lomefloxacin for acute pyelonephritis treatment.
- To evaluate levofloxacin's suitability as an empiric treatment option.
Main Methods:
- Two randomized, multicenter trials involving 186 patients with bacteriologically confirmed infections.
- Patients received levofloxacin (250 mg once daily), ciprofloxacin (500 mg twice daily), or lomefloxacin (400 mg once daily).
- Primary endpoint was microbiologic response; secondary endpoint was clinical response.
Main Results:
- High uropathogen eradication rates: 95% for levofloxacin, 94% for ciprofloxacin, 95% for lomefloxacin.
- Clinical cure rates were 92% for levofloxacin, 88% for ciprofloxacin, and 80% for lomefloxacin.
- Levofloxacin had a lower incidence of drug-related adverse events (2%) compared to ciprofloxacin (8%) and lomefloxacin (5%).
Conclusions:
- Levofloxacin shows comparable efficacy to ciprofloxacin and lomefloxacin in treating acute pyelonephritis.
- Once-daily oral levofloxacin is well-tolerated and effective for empiric treatment.
- Levofloxacin presents an excellent therapeutic option for acute pyelonephritis management.