Levofloxacin (Levaquin) versus Other
According to the studies, the rank order of phototoxic potential of
fluoroquinolones is as follows: enoxacin> ciprofloxacin > norfloxacin
= ofloxacin = levofloxacin = gatifloxacin = moxifloxacin 1,
Based on published literature, the approximate order of fluoroquinolones
in which they significantly interact with theophylline is as follows:
enoxacin > ciprofloxacin > norfloxacin > ofloxacin, levofloxacin, trovafloxacin,
The side-effect profile of levofloxacin was compared with that of other
fluoroquinolones based on European and international data from approximately
130 million prescriptions 12.
Levofloxacin was found to be very safe with a low rate of hepatic abnormalities
(1/650,000). The main CNS problems associated with fluoroquinolones
include dizziness, convulsions, psychosis, and insomnia. Levofloxacin,
ofloxacin, and moxifloxacin reportedly have the lowest potential of
inducing central nervous system (CNS) adverse events among the fluoroquinolones
currently available. Cardiovascular problems were seen in 1/15 million
levofloxacin prescriptions compared to 1-3% of sparfloxacin patients
having QTc prolongation of greater than 500 msec. Moxifloxacin was also
associated with QTc prolongation when compared to non-fluoroquinolone
comparators. Nausea, vomiting, and diarrhoea remain the main adverse
drug reactions associated with levofloxacin. However, the ADR rate for
levofloxacin is still one of the lowest of any fluoroquinolone at 2%
(compared to 2-10% for other fluoroquinolones). The tolerance profile
of levofloxacin can be considered to be very good, and better than most,
if not all of the fluoroquinolones available.
Levofloxacin (Levaquin) vs. Ciprofloxacin
- Skin and Skin Structure Infections:
Among 253 patients (129 levofloxacin, 124 ciprofloxacin), clinical
success (cure and improvement) was observed in 96.1% of levofloxacin-treated
patients and in 93.5% of ciprofloxacin-treated patients. Bacteriological
eradication rates by pathogen were 93.2% and 91.7%, respectively.
Levofloxacin eradicated 94% (66/70) of Staphylococcus aureus and 94%
(17/18) of Streptococcus pyogenes isolates, compared with 93% (70/75)
and 92% (12/13) for ciprofloxacin. Microbiological eradication rates
by subject were approximately 93% and 90% for the levofloxacin and
ciprofloxacin groups, respectively. Drug-related adverse events were
reported by 8.9% of those receiving levofloxacin and 8.2% of those
administered ciprofloxacin 10.
- Acute Pyelonephritis, Urinary tract infections (UTI):
Levofloxacin 750 mg once daily for 5 days is at least as effective
as ciprofloxacin 400 mg or 500 mg twice daily for 10 days in the treatment
of acute pyelonephritis 13.
In the modified intent-to-treat (mITT) population (levofloxacin 94,
ciprofloxacin 98), 83% of levofloxacin-treated and 79.6% of ciprofloxacin-treated
subjects achieved microbiological eradication (difference 3.4, 95%
CI 14.4%, 7.6%). In the microbiologically evaluable (ME) population
(levofloxacin 80, ciprofloxacin 76), 92.5% of levofloxacin-treated
vs. 93.4% of ciprofloxacin-treated subjects (difference 0.9, 95% CI
7.1%, 8.9%) achieved microbiologic eradication. Clinical success was
achieved in 86.2% vs. 80.6% (mITT) and in 92.5% vs. 89.5% (ME) of
levofloxacin-treated and ciprofloxacin-treated subjects, respectively.
Escherichia coli was the most commonly isolated uropathogen. Few (2.1%)
of the pathogens were fluoroquinolone-resistant. Adverse events (AEs)
were similar to those seen previously with both agents. Potential
limitations are that this analysis is based on a subset of subjects
from a larger study and, because of different durations of therapy,
the results may be biased against levofloxacin.
- Chronic bacterial prostatitis:
Levofloxacin 500 mg once daily for 28 days is as effective as ciprofloxacin
500 mg twice daily for 28 days for the treatment of chronic bacterial
prostatitis. The clinical success rates, including cured plus improved
patients, were similar (75% for levofloxacin and 72.8% for ciprofloxacin).
Microbiologic eradication rates were 75% for levofloxacin and 76.8%
for ciprofloxacin 5.
Levofloxacin (Levaquin) vs. Lomefloxacin
- Urinary Tract Infections:
Once-daily levofloxacin is as effective as and has a superior tolerability
profile than lomefloxacin in the treatment of complicated UTIs 11.
Microbiologic eradication rate of pathogens was 95.5% for levofloxacin
and 91.7% for lomefloxacin. At the 5 to 9-day post-therapy visit,
symptoms were completely resolved in 84.8% of levofloxacin-treated
patients and were decreased in 8.2% (93.0% clinical success). Among
the lomefloxacin-treated patients, complete resolution was seen in
82.4%, with decreased symptoms in 6.1% (88.5% clinical success). Side
effects were reported by 10 (2.6%) and 18 (5.2%) levofloxacin- and
lomefloxacin-treated patients, respectively. Compared with levofloxacin-treated
patients, more lomefloxacin-treated patients experienced photosensitivity
reactions and dizziness. Nausea was more frequent in the levofloxacin-treated
group. Six patients in each group had a gastrointestinal
side effects (1.7%); rash was reported more frequently with lomefloxacin
than with levofloxacin. Discontinuation because of side effects was
occurred in 8 (3.4%) levofloxacin- and 14 (6.1%) lomefloxacin-treated
- Acute Pyelonephritis:
Predominant organism was E. coli Eradication rates similar 95%(Le)
95%(Lo) Relapse rates were similar Clinical cure (microbiologic and
clinical success) rates 92%(Le) 80%(Lo) Rates of clinical success
(cure plus improvement) were similar Adverse events 2%(Le) 5%(Lo)
Levofloxacin (Levaquin) vs. Clarithromycin
- Bacterial exacerbation of chronic obstructive pulmonary disease
In the study levofloxacin and clarithromycin showed similar exacerbation-free
intervals. The bacteriological eradication rate was significantly
higher with the levofloxacin treatment 4.
- Community-acquired pneumonia:
Clarithromycin ER has equivalent efficacy and tolerability to the
levofloxacin in the treatment of community-acquired pneumonia 7.
Of 299 patients randomized and treated, 252 were clinically evaluable
(128 clarithromycin ER, 124 levofloxacin). Clinical cure rates were
88% (113/128) and 86% (107/124), and radiographic success rates were
95% (117/123) and 88% (104/118) for clarithromycin ER and levofloxacin,
respectively. Both treatment regimens were effective in resolving
and improving clinical signs and symptoms of CAP. Bacteriologic cure
rates were 86% (80/93) and 88% (85/97) for clarithromycin ER and levofloxacin,
- Acute sinusitis:
The study showed that, in the treatment of acute sinusitis, daily
levofloxacin therapy is as effective as twice-daily clarithromycin
therapy with more complete clearing of symptoms and a more tolerable
side-effect profile 8.
The proportion of cured patients was higher in the levofloxacin (40.8%)
than in the clarithromycin group (29.0%). Of patients receiving levofloxacin
and clarithromycin, 22.5% and 39.3%, respectively, experienced adverse
events related or possibly related to the study therapy.
Levofloxacin (Levaquin) vs. Azithromycin
- Acute bacterial exacerbations of chronic bronchitis.
Standard 5-day course of oral azithromycin was clinically and bacteriologically
equivalent to a 7-day course of oral levofloxacin in the treatment
of ABECB. Favorable results were demonstrated in 89% of patients receiving
azithromycin and in 92% of patients receiving levofloxacin by day
4 of therapy. At day 24 favorable responses were approximately 82%
and 86%, respectively. The bacterial eradication rates of respiratory
pathogens were 96% for azithromycin and 85% for levofloxacin 6.
Both treatments are well-tolerated, with the majority of adverse events
being GI in nature.
- Community-acquired pneumonia:
A single 2 g dose of azithromycin microspheres is at least as effective
as a 7-day course of levofloxacin in the treatment of mild to moderate
community-acquired pneumonia 16.
The cure rates were 89.7% for azithromycin microspheres and 93.7%
for levofloxacin. Bacteriologic success at test of cure in the "bacteriologic
per protocol" population was 90.7% for azithromycin microspheres and
92.3% for levofloxacin. Both medications were well tolerated. The
incidence of side effects was 19.9% for azithromycin and 12.3% for
Single 2 g dose azithromycin microspheres has efficacy comparable
to 10 days of levofloxacin in the treatment of acute bacterial sinusitis
Clinical success rates were 94.5% with azithromycin-microspheres and
92.8% with levofloxacin. In patients with Streptococcus pneumoniae,
Haemophilus influenzae, or Moraxella catarrhalis, clinical cure rates
were 97.3%, 96.3%, and 100%, respectively, for the azithromycin and
92.3%, 100%), and 90.9%, respectively, for the levofloxacin.
Levofloxacin (Levaquin) vs. Cefuroxime axetil
- Acute bacterial exacerbations of chronic bronchitis (ABECB):
The clinical response was rated a success, with the patient cured
or improved in 94.6% of those receiving levofloxacin and 92.6% of
the cefuroxime axetil group. All of the symptoms of bronchitis were
resolved in more than 86% of the patients, with the exception of shortness
of breath, which resolved in 69.7% of levofloxacin-treated and 72.4%
of cefuroxime axetil-treated patients. Resolution or improvement of
abnormalities on thoracic auscultation were noted in 85% or more of
patients, with the exception of diminished breath sounds, which were
resolved or improved in 62.5% of levofloxacin-treated and 55.2% of
cefuroxime axetil-treated patients 3.
- Community-acquired pneumonia:
Levofloxacin is superior to ceftriaxone and/or cefuroxime axetil in
the treatment of community-acquired pneumonia 14.
Clinical success was higher with levofloxacin treatment (96%) compared
with the ceftriaxone and/or cefuroxime axetil (90%). In patients with
typical respiratory pathogens the bacteriologic eradication rates
were higher with levofloxacin (98%) compared with the ceftriaxone
and/or cefuroxime axetil (85%). Levofloxacin eradicated 100% of the
most frequently reported respiratory pathogens (i.e., H. influenzae
and S. pneumoniae) and provided a >98% clinical success rate in patients
with atypical pathogens. Side effects were reported in 5.8% of patients
receiving levofloxacin and in 8.5% of patients receiving ceftriaxone
and/or cefuroxime axetil. Gastrointestinal and central and peripheral
nervous system adverse events were the most common events reported
with each treatment.
Levofloxacin is more effective than cefuroxime for the treatment of
In the study the treatment success rates were 97.4% for patients who
received levofloxacin and 92.8% for patients who received cefuroxime.
The resolution rates of bacteria were 91.6% and 80.0%, respectively.
Levofloxacin (Levaquin) vs. Cefdinir (Omnicef)
Cefdinir is effective as the levofloxacin in the treatment of acute
Clinical cure rate at the test-of-cure visit in the cefdinir group
was 83% and in the levofloxacin group 86%. Cefdinir and levofloxacin
were comparable in the treatment of moderate to severe infections.
The incidence of drug side effects was generally comparable in the
2 treatment groups, although there were significant differences between
cefdinir and levofloxacin in the incidence of vaginal moniliasis in
women (11% vs 0%), diarrhea (8% vs 1%), and insomnia (0% vs 4%).
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Published: March 31, 2008
Last updated: April 10, 2012