Open-label, randomized comparison trial of long-term outcomes of levofloxacin versus standard antibiotic therapy in acute exacerbations of chronic obstructive pulmonary disease

BACKGROUND AND OBJECTIVE: This study investigated whether treating acute exacerbations of COPD (AE-COPD) with levofloxacin modifies the long-term outcome of COPD patients in comparison with standard antibiotic regimens. METHODS: A 6-month open-label clinical trial of AE-COPD patients compared the outcomes of treating with levofloxacin versus standard therapy (clarithromycin, cefuroxime, or amoxicillin/clavulanate) at recommended doses for 10 days. Several variables were analysed: pulse oximetry, FEV1, health-related quality of life, infection-free interval, number of exacerbations, hospitalizations due to an exacerbation and mortality. RESULTS: Of the 116 patients initially enrolled, completion or withdrawal information was available for 50 patients in the levofloxacin arm and 52 in the standard therapy arm. At the end of the study, there were no differences in mortality (17.8% vs. 22.9%, P = 0.53), number of exacerbations (33 vs. 41, P = 0.40), pulse oximetry (median 91.71% vs. 92.46%, P = 0.18), FEV1 (median 51.31% vs. 47.14%, P = 0.30), health-related quality of life (median 8.63 vs. 10.75, P = 0.94) and infection-free interval (median 112 vs. 101 days, P = 0.72), for the levofloxacin and standard therapy, respectively. However, 12 out of 33 (33.6%) exacerbations treated with levofloxacin required in-hospital management versus 27 out of 41 (65.8%) treated with standard therapy (P = 0.02). CONCLUSION: This preliminary study suggests that 10-day treatment of AE-COPD with levofloxacin is associated with a reduction in hospitalizations compared with standard antibiotics despite there being no significant benefit in other outcome variables.     

加替沙星和左氧氟沙星序贯治疗尿路感染的成本-效果比较

目的对加替沙星和左氧氟沙星序贯治疗尿路感染进行成本-效果比较分析。方法将85例尿路感染患者随机分成两组,A组42例给予加替沙星序贯疗法,B组43例给予左氧氟沙星序贯疗法,运用药物经济学方法最小成本-效果分析。结果A组和B组的总有效率分别为85．71％和88．37％,细菌清除率分别为90．48％和93．02％,不良反应发生率分别为7．14％和4．65％,成本效果比分别为2．42和1．87。结论对于尿路感染患者,采用左氧氟沙星序贯疗法比加替沙星序贯疗法具成本-效果优势,值得临床应用推广。     

莫西沙星与左氧氟沙星治疗细菌性感染懿细菌学疗效比较的Meta分析

目的分析比较莫西沙星与左氧氟沙星治疗细菌性感染的细菌学疗效。方法应用RevMan4．2软件对国内2000年至2007年13项莫西沙星和左氧氟沙星治疗细菌性感染的研究进行同质性检验和合并效应量的估计。结果同质性检验X^2=11．05,自由度为10,P=0．35;合并效应量的估计OR合并=2．08,0R合并95％可信限为1．26-3．45;OR合并的检验Z=2．87,P〈0．01。结论莫西沙星治疗细菌性感染的细菌学疗效优于左氧氟沙星。     

Levofloxacin pharmacokinetics in adult cystic fibrosis

BACKGROUND: Cystic fibrosis (CF) patients have enhanced renal clearance of aminoglycosides and several beta-lactams and require higher dosages. Levofloxacin is a fluoroquinolone with extensive renal elimination and enhanced penetration into lungs and Pseudomonas aeruginosa (PA) biofilms. We studied the preliminary pharmacokinetic and pharmacodynamic (PK/PD) relationship of levofloxacin in CF. METHODS: Twelve patients at least 18 years old with a mild-to-moderate pulmonary exacerbation and fluoroquinolone-sensitive PA colonization received oral levofloxacin, 500 mg qd, for 14 days. Steady-state serum concentrations were collected after 3 to 7 days, and sputum samples for PA densities were collected before and after levofloxacin. PK/PD relationships for reducing PA sputum densities were evaluated. RESULTS: When compared to published data on non-CF patients, CF patients had similar area under the curve for 24 h (AUC(24)), total clearance, volume of distribution, maximum serum concentration (Cpmax), and elimination half-life: mean, 7.33 microg x h/mL/kg (SD, 1.70); 2.43 mL/min/kg (SD, 0.74); 1.33 L/kg (SD, 0.37); 7.06 microg/mL (SD, 2.35); and 6.44 h (SD, 1.1), respectively. Time to reach maximum serum concentration (Tmax) in CF was longer: mean, 2.20 h (SD, 0.99) vs 1.1 h (SD, 0.4) [p < 0.01]. Preliminary PK/PD analysis failed to demonstrate trends for decreasing PA sputum densities with increasing Cpmax/minimum inhibitory concentration (MIC) ratio and AUC(24)/MIC ratio. CONCLUSION: CF levofloxacin pharmacokinetics corrected for body weight are similar to non-CF, except for Tmax. Standard levofloxacin dosing (especially monotherapy) is unlikely to produce maximum therapeutic effectiveness. Additional levofloxacin studies in CF are necessary to evaluate its sputum concentrations; the benefits of higher daily dosages (>/= 750 mg); and establish PK/PD targets for managing PA pulmonary infections.     

普卢利沙星片治疗急性细菌性感染随机双盲对照临床研究

目的 评价普卢利沙星片(第4代喹诺酮类抗生素)治疗临床常见细菌性感染的安全性和有效性.方法 采用多中心、随机、双盲、平行对照试验设计,共入选病例255例,进入PP(符合方案集)分析249人,其中:试验组124例,对照组125例.口服普卢利沙星片和左氧氟沙星片均每次200 mg,每日2次,疗程7-14天.结果 试验组和对照组临床痊愈率分别为90.32%和85.60%,总有效率分别为95.97%和95.20%,细菌清除率分别为100%和98.98%;药物不良反应发生率分别为6.25%和3.94%.结论 普卢利沙星片治疗急性呼吸和泌尿系统感染安全、有效.     

左氧氟沙星严重不良反应

目的评价、分析左氧氟沙星的严重不良反应。方法查阅、汇总、分析医药文献所报道的左氧氟沙星的不良反应。结果左氧氟沙星严重不良反应以中枢及外周神经系统损害、皮肤及其附件损害、呼吸系统损害、胃肠系统损害为主,其中过敏反应问题较为典型。结论左氧氟沙星临床使用广泛,应关注其不良反应及临床应用的安全性。     

左氧氟沙星对幽门螺杆菌感染补救治疗疗效观察

目的探讨左氧氟沙星三联方案对幽门螺杆菌感染进行补救治疗的疗效。方法64例患者经胃镜以及病理检查证实为消化性溃疡,并且经一线治疗方案根除失败,给予雷贝拉唑10mg,左氧氟沙星200mg,阿莫西林1000mg,2次／d,疗程7d。治疗4周后行^14C呼气试验。结果64例患者中56例HP阴性,根除率为87．5％,其中仅有2例出现轻度不良反应。结论对HP根除治疗失败的患者左氧氟沙星为安全有效的补救治疗方案。     

The current state of antibacterial research

‵...some would say that the era of once-daily HAART is upon us. Others would advocate for randomized controlled trials including more established twice-daily combinations before such a statement can be made. Although these studies may be interesting, there are a number of individual patients who will not wait.′     

Comparison of drug susceptibility between Escherichia coli detected in stool cultures of patients undergoing transrectal prostate needle biopsy and Escherichia coli in hospital-wide urine antibiograms

A prostate biopsy is essential for prostate cancer diagnosis. However, infections are one of the biopsy-associated complications, and post-biopsy fever is estimated to occur in approximately 1% of all cases. It may thus be beneficial to perform a rectal swab culture before a transrectal prostate biopsy to confirm the presence of resistant bacteria and select preventive antibacterial agents according to the drug susceptibility results. This study aimed to determine whether there is a difference between the drug susceptibility of bacteria detected in the stool of patients who were scheduled to undergo prostate biopsy and the hospital-wide urine antibiogram. Patients suspected of having prostate cancer who underwent transrectal prostate biopsy via transrectal ultrasonography between August 1, 2016, and June 30, 2020, were included in this study. Stool samples were collected and cultured before biopsy. Overall, 99 patients underwent prostate biopsy, and of these, culture results were available for 81 patients (81.8%). Escherichia coli was detected in 74.0% (60 samples) of the stool culture samples, of which 4 samples were extended-spectrum β-lactamase-producing types. We found greater susceptibility of Escherichia coli to ampicillin, fluoroquinolones, sulfamethoxazole/trimethoprim, and cefixime in the stool culture antibiogram than in the hospital-wide urine antibiogram. We also found a significantly low incidence of ESBL-positive Escherichia coli in the stool culture antibiogram with p-values of 0.009, 0.007, and 0.03 compared to the hospital-wide urine antibiograms for 2017, 2018, and 2019, respectively. Stool culture of prostate cancer patients undergoing biopsy may provide useful information for selecting prophylactic antimicrobial agents.     

左氧氟沙星对呼吸道和泌尿道感染常见病原菌的体外抗菌活性研究

目的了解左氧氟沙星对呼吸道和泌尿道感染常见病原菌的体外抗菌活性，指导临床合理应用抗菌药物。方法常规分离培养细菌，用VITEKⅡ全自动细菌鉴定分析仪和API细菌鉴定系统鉴定到种。药敏试验用琼脂平板稀释法检测MIC，按NCCLs规定的标准进行。结果呼吸道和泌尿道感染的标本中分离获得了131株病原菌，常见的为大肠埃希菌、嗜血杆菌、表皮葡萄球菌、肺炎克雷伯菌、粪肠球菌等。左氧氟沙星对常见菌株的最低抑菌浓度（MIC）在0．06—64mg／L之间，总的抑菌率为90．1％。结论左氧氟沙星是一种有效的广谱抗菌药物，对呼吸道和泌尿道常见病原菌的抗菌活性较高，可以作为治疗呼吸道和泌尿道感染的一线药物。