Levofloxacin (Levaquin) versus ...
- Levofloxacin vs Moxifloxacin
- Levofloxacin vs Ciprofloxacin
- Levofloxacin vs Lomefloxacin
- Levofloxacin vs Clarithromycin
- Levofloxacin vs Azithromycin
- Levofloxacin vs Cefuroxime axetil
- Levofloxacin vs Cefdinir
Based on "Antibiotic and Chemotherapy"
written by Roger G. Finch
According to the studies, the rank order of phototoxic potential of fluoroquinolones is as follows: enoxacin> ciprofloxacin > norfloxacin = ofloxacin = levofloxacin = gatifloxacin = moxifloxacin 1, 2.
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, gatifloxacin, moxifloxacin.
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 toxicity (1/650,000). The main central nervous system 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 reported 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.
Urinary Tract Infections
Levofloxacin is as effective as lomefloxacin in the treatment of complicated UTIs 11. Levofloxacin has a superior tolerability profile than lomefloxacin.
| Results of controlled trial of levofloxacin and lomefloxacin in the treatment of complicated urinary tract infection 11. | Levofloxacin | Lomefloxacin |
|---|---|---|
| Regimen | 250 mg once daily for 7 to 10 days | 400 mg once daily for 14 days |
| The overall microbiologic eradication rate | 95.5% (168 patients of 176) |
91.7% (154 patients of 168) |
| Eradication rates with respect to patients | 95.3% (163 patients of 171) |
92.1% (152 patients of 165) |
| Complete resolution of symptoms at the 5 to 9-day post-therapy | 84.8% |
82.4% |
| Decreased symptoms | 8.2% |
6.1% |
| Clinical success rate | 93% |
88.5% |
| Adverse events | 10 patients (2.6%) |
18 patients (5.2%) |
Photosensitivity reactions |
0 |
3 patients (1.3%) |
Dizziness |
0 |
2 patients (0.9%) |
| Nausea |
3 patients (1.3%) |
1 patients (0.4%) |
Gastrointestinal |
6 patients (1.7%) |
6 patients (1.7%) |
Rash |
1 patient (0.4%) | 4 patients (0.4%) |
| Discontinuation because of adverse events observed in 8 (3.4%) levofloxacin- and 14 (6.1%) lomefloxacin-treated patients. | 8 patients (3.4%) |
14 patients (6.1%) |
Acute Pyelonephritis
Levofloxacin is more effective than lomefloxacin in the treatment of acute pyelonephritis9
| Results of trial comparing levofloxacin with lomefloxacin for acute pyelonephritis 9 | Levofloxacin | Lomefloxacin |
|---|---|---|
| Regimen | 250 mg once daily | 400 mg once daily |
| Eradication of uropathogens rate at 5 to 9 days after the end of treatment (predominant pathogen E. coli) | 95% |
95% |
| Clinical cure rate | 92% |
80% |
| Adverse events | 2% |
5% |
Bacterial exacerbation of chronic obstructive pulmonary disease (COPD)
Levofloxacin and clarithromycin provide similar COPD exacerbation-free periods. Levofloxacin treatment results in significantly higher bacteriological eradication rate 4.
| Results of study comparing levofloxacin versus clarithromycin in COPD exacerbation4. | Levofloxacin | Clarithromycin |
|---|---|---|
| Regimen | 7 days course | 10 days course |
| Exacerbation-free interval | 300 days |
350 days |
| Exacerbation-free interval for patients with a new documented exacerbation during follow-up | 100.5 days |
95 days |
| Clinical success rates | Similar |
|
| Bacteriological success rate | significantly higher | |
Community-acquired pneumonia
Clarithromycin ER has equivalent efficacy and tolerability to the levofloxacin in the treatment of community-acquired pneumonia 7.
| Results of study comparing clarithromycin ER and levofloxacin for community-acquired pneumonia7. | Levofloxacin | Clarithromycin |
|---|---|---|
| Regimen | 500 mg once daily for 7 days | 1000 mg once daily for 7 days |
| Clinical cure rates | 86% (107 patients of 124) |
88% (113 patients of 128) |
| Radiographic success rates | 88% (104 patients of 118) |
95% (117 patients of 123) |
| Bacteriologic cure rates | 88% (85 patients of 97) |
86% (80 patients of 93) |
Acute sinusitis
Daily levofloxacin therapy is as effective as twice-daily clarithromycin therapy with more complete clearing of symptoms and better tolerability 8.
| Results of study comparing levofloxacin with clarithromycin in the treatment of acute sinusitis in adults 8. | Levofloxacin | Clarithromycin |
|---|---|---|
| Regimen | 500 mg once daily for 10-14 days | 500 mg twice daily for 10-14 days |
| Clinical response rates (cured plus improved) | 93.9% (98 patients of 119) |
93.5% (93 patients of 117) |
| Proportion of cured patients | 40.8% |
29.0% |
| Resolution of individual symptoms | higher rates |
|
| Adverse events | 22.5% |
39.3% |
Acute bacterial exacerbations of chronic bronchitis
Standard 5-day course of azithromycin was clinically and bacteriologically equivalent to a 7-day course of oral levofloxacin in the treatment of ABECB 6.
| Results of trial of azithromycin vs levofloxacin in the outpatient treatment of acute bacterial exacerbations of chronic bronchitis6. | Levofloxacin | Azithromycin |
|---|---|---|
| Regimen | 500 mg daily for 7 days | 500 mg on day 1; 250 mg daily for days 2 to 5 |
| Favorable clinical results by day 4 of therapy | 92% |
89% |
| Favorable clinical results by day 24 of therapy | 86% |
82% |
| Bacterial eradication rates of respiratory pathogens | 85% |
96% |
Community-acquired pneumonia
Azithromycin microspheres (single 2 g dose) is at least as effective as a levofloxacin in the treatment of mild to moderate community-acquired pneumonia 16.
| Results noninferiority study of microsphere formulation of azithromycin versus levofloxacin for mild to moderate community-acquired Pneumonia in adults.16. | Levofloxacin | Azithromycin microspheres |
|---|---|---|
| Regimen | 500 mg daily for 10 days | single 2.0 g dose |
| Clinical cure rate | 93.7% |
89.7% |
| Bacteriologic success | 92.3% (120 patients of 130) |
90.7% (97 patients of 107) |
| Adverse events | 12.3% |
19.9% |
| Tolerability | well tolerated | |
Sinusitis
Azithromycin microspheres (as a single 2 g dose) has efficacy comparable to 10 days of levofloxacin in the treatment of acute bacterial sinusitis 10.
| Results of international trial comparing azithromycin microsphere formulation versus levofloxacin for acute bacterial sinusitis in adults 10. | Levofloxacin | Azithromycin |
|---|---|---|
| Regimen | 500 mg daily for 7 days | single 2.0 g dose |
| Clinical success rates | 92.8% |
94.5% |
| Clinical success rates in patients with documented causative organism: | ||
| Streptococcus pneumoniae | 92.3% (36/39) |
97.3% (36/37) |
| Haemophilus influenzae | 100% (30/30) |
96.3% (26/27) |
| Moraxella catarrhalis | 90.9% (10/11) |
100% (8/8) |
Acute bacterial exacerbations of chronic bronchitis (ABECB)
Both levofloxacin and cefuroxime axetil provide high rate of clinical efficacy and are equally well tolerated.
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.
| Results of study comparing the efficacy of antimicrobial therapies in AECOB 3. | Levofloxacin | Cefuroxime axetil |
|---|---|---|
| Regimen | 500 mg daily for 10 days | 250 mg twice daily for 10 days |
| Clinical cure rate | 94.6% |
93.8% |
| The probability that 25% of patients would relapse during follow-up was reached within | 93 days |
81 days |
| Safety | comparable |
|
| Adverse events | 5.0% |
2.9% |
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.
Sinusitis
Levofloxacin is more effective than cefuroxime for the treatment of sinusitis 15.
| Results of comparison of the effectiveness of levofloxacin and cefuroxime for sinusitis 15. | Levofloxacin | Cefuroxime axetil |
|---|---|---|
| Regimen | 200 mg once daily, 200/100 mg twice daily for 10 to 14 days | 250 mg twice daily for 10 to 14 days |
| Success rate | 97.4% |
92.8% |
| Resolution of bacteria rates | 91.6% |
80.0% |
Rhinosinusitis
Cefdinir is as effective as levofloxacin in the treatment of acute rhinosinusitis 17.
| Results of study comparing cefdinir and levofloxacin in acute rhinosinusitis 17. | Levofloxacin | Cefdinir |
|---|---|---|
| Regimen | 500 mg daily for 10 days | 600 mg daily for 10 days |
| Clinical cure rates at the test-of-cure visit | 86% (101 patients of 118) |
83% (102 patients of 123) |
| Efficacy in the treatment of moderate to severe infections | comparable | |
| Incidence of side effects | comparable | |
| Incidence of: | ||
| vaginal moniliasis in women (candidiasis) |
0% |
11% |
diarrhea |
1% |
8% |
insomnia |
4% |
0% |
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Published: March 31, 2008
Last reviewed: May 24, 2017
