levofloxacin

Fluoroquinolones represent a class of antibiotics commonly used to manage Pseudomonas aeruginosa infections. The appearance of fluoroquinolone resistance in P. aeruginosa represents a critical challenge to healthcare systems.

Between January and December 2024, 650 clinical specimens were collected from Al-Hussein Teaching Hospital and Al-Rumaitha Hospital in Al-Muthanna, Iraq. P. aeruginosa was identified by conventional biochemical assays and confirmed with the Vitek 2® system. Susceptibility testing was performed by disk diffusion. PCR was conducted to detect plasmid-mediated quinolone resistance determinants, namely qnrA, qnrB, qnrD, qnrS, aac(6′)-Ib-cr, and qepA.

Among the 650 specimens analyzed, 374 (57.54%) were positive for bacterial culture, with P. aeruginosa representing 40.10% (150/374) of the identified isolates. Among these, 39 (26%) exhibited resistance to at least one fluoroquinolone used. The most frequently detected gene was qnrB (67.65%), followed by qnrD (61.76%), qnrS (55.88%), aac(6')-Ib-cr (47.00%), and qepA (41.17%), while qnrA and qnrC were not detected in any isolate.

The fluoroquinolone resistance and widespread occurrence in isolates of P. aeruginosa from Al-Muthanna Province pose a challenge to infection management, as mobile genetic elements facilitate the rapid dissemination of resistance and limit available therapeutic options, emphasizing the necessity for genetic monitoring and effective antibiotic management.

Antimicrobial resistance poses a significant global health threat. A previously developed penta-amino acid ultrashort antimicrobial peptide (UP5), with alternating arginine and biphenylalanine units, showed strong antimicrobial activity, particularly in combination with levofloxacin. However, differences in pharmacokinetics between UP5 and levofloxacin may hinder their optimal clinical use. This study aimed to develop a covalent UP5-levofloxacin conjugate that retains the synergistic antimicrobial properties of both UP5 and levofloxacin.

Experimental approach: 

The UP5-levofloxacin conjugate was synthesized and tested for antimicrobial activity against multidrug-resistant gram-positive (Enterococcus faecium, Staphylococcus aureus, Staphylococcus epidermidis) and gram-negative bacteria (Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa). Hemolytic activity was assessed on human erythrocytes, and selectivity against MDCK cells was determined. Comparative analysis was performed with individual components.

The conjugate exhibited synergistic antimicrobial activity with minimum inhibitory concentration (MIC) values between 2.5 and 20 µM, overcoming levofloxacin resistance. It showed minimal hemolytic activity < 1% and a favorable selectivity index of 4.4-35.2. Cytotoxicity studies indicated selective toxicity towards MDCK cells, with an IC50 of 88.34 µM, significantly higher than its MIC values.

Conclusion and implications: 

The UP5-levofloxacin conjugate demonstrated enhanced antimicrobial efficacy against resistant bacteria, with minimal hemolytic activity and favorable selectivity toward normal cells. This conjugate presents a promising approach to combating antimicrobial resistance, offering potential for improved therapeutic strategies.

Levofloxacin, as a prototypical agent of the third generation of fluoroquinolones, is an antimicrobial agent routinely administered for treating bacterial keratitis. Levofloxacin is available under different trade names as liquid pharmaceutical formulations, such as infusions and eye drops.

This paper reports a fast, simple, accurate, and precise high-performance liquid chromatography (HPLC) technique for levofloxacin determination in liquid pharmaceutical formulations.

The HPLC method was applied using a photodiode array detector (DAD), and measurements were conducted at a 294 nm UV-Vis wavelength. The technique was developed to enable the immediate estimation of levofloxacin in the Oftaquix (5 mg/mL) ophthalmic formulation. The ODS-phenyl column was used and maintained at 30 ± 2°C and 294 nm λmax conditions. A mixture of acetonitrile: 0.1% trifluoroacetic acid (18:82 v/v) was used as the mobile phase, with a flow rate of 1.5 mL/min. The method was validated in relation to system suitability, accuracy, linearity, and precision in agreement with International Conference on Harmonization (ICH) and Food and Drug Administration (FDA) guidelines.

The levofloxacin peak was eluted at 9.5 minutes with good resolution. The calibration curve was linear within the 50 - 150 μg/mL range with a linearity coefficient higher than 0.9999. The limit of detection (LOD) and limit of quantification (LOQ) of the developed method were 2.13 and 6.47 μg/mL, respectively, and the lowest concentration from the calibration curve is obtained as 50.19 ± 0.24 μg/mL. The average inter- and intraday precision was in the range of 96.465 ± 0.0080 - 97.060 ± 0.0034%. Analyzing the amount of drug in Oftaquix 5 mg/mL ophthalmic solution revealed a 4.96 mg/mL levofloxacin in this formulation, with 99.3% accuracy and 0.84% relative standard deviation (RSD) value.

The HPLC-DAD method developed in this study can be applied for routine analysis of levofloxacin amounts in pharmaceutical formulations and bioequivalence studies in quality control departments and the pharmaceutical industry.

Ventilator-associated pneumonia (VAP) caused by multidrug-resistant Gram-negative bacteria (MDR-GNB) is a major intensive care unit challenge, particularly in Iran, due to limited antibiotic options. This study compared the efficacy of adding levofloxacin and colistin inhalation form to the baseline regimen of colistin and meropenem in treating VAP caused by MDR-GNB.

Patients with VAP were randomly assigned to the colistin group (n = 24), receiving 2 million international unit (MIU) every 8 h, and the levofloxacin group (n = 22), receiving 250 mg every 12 h, alongside intravenous colistin (4.5 MIU every 12 h) and meropenem (1 g every 8 h). Clinical improvement using the Clinical Pulmonary Infection Score (CPIS) on days 1, 5, and 7, the clinical response on day 7, and inflammatory markers (erythrocyte sedimentation rate and C-reactive protein) on days 1, 3, 5, and 7 were evaluated.

CPIS scores significantly decreased in both groups: Colistin (−3.67 ± 2.14, P < 0.001) and levofloxacin (−4.41 ± 1.71, P < 0.001), with no intergroup difference (P = 0.200). The clinical response analysis indicated that levofloxacin was associated with fewer treatment failures and more partial responses, whereas colistin demonstrated higher rates of complete response; however, these differences were not statistically significant (P > 0.05). Acute kidney injury occurred only in the colistin group (n = 8; 33.3%). Bronchospasm and cough occurred in one levofloxacin patient (4.54%), showing a significant difference in adverse effects (P = 0.004). Mortality rates were higher in the colistin group (n = 17; 70.8%) compared to the levofloxacin group (n = 10; 45.5%), though this difference was not statistically significant (P = 0.08).

Levofloxacin inhalation may be considered an effective alternative to colistin inhalation for treating VAP caused by MDR‑GNB. It offers similar efficacy and lower nephrotoxicity.

Antibiotic resistance and adverse effects pose significant challenges to the effectiveness of Helicobacter pylori eradication therapies, such as clarithromycin-based triple therapy. Alternative treatments, including bismuth quadruple therapy, are effective in cases of clarithromycin resistance. Levofloxacin and metronidazole-based triple therapy have demonstrated high success rates with fewer side effects, making it a preferred option following clarithromycin treatment failure.

This study aimed to evaluate the effectiveness of levofloxacin and metronidazole in eradicating H. pylori among patients with chronic epigastric pain in Zakho, Iraq. It also assessed the accuracy of diagnostic tests, patient history, and post-treatment confirmation of eradication.

A prospective study was conducted involving 100 patients with chronic epigastric pain at Zakho General Teaching Hospital. Diagnosis was performed using the fecal antigen test, urea breath test (UBT), and endoscopy with biopsy. Patients were treated with a 14-day regimen comprising levofloxacin, metronidazole, and either esomeprazole or pantoprazole.

Of the 100 participants, 66% were female, with a mean age of 37.85 years. The fecal antigen test, performed on 60 patients, showed a positivity rate of 96.5%, while the UBT, conducted on 40 patients, revealed a positivity rate of 97.5%. The highest infection rate was observed in the 51 - 60 age group. The 14-day levofloxacin and metronidazole regimen achieved a 99% eradication rate with minimal side effects.

This study underscores the high efficacy of levofloxacin and metronidazole-based therapy for H. pylori eradication. It highlights the importance of non-invasive diagnostic methods, enhanced patient follow-up, and international collaboration to achieve optimal treatment outcomes.

Bronchiectasis is a chronic pulmonary disease characterized by abnormal and permanent dilatation of the airways in the lung. This study was conducted to compare the effect of levofloxacin with azithromycin in improving the lung function of these patients.

In this parallel double-blinded randomized clinical trial, 72 patients with exacerbated bronchiectasis were included and randomly divided into two intervention groups. One group was treated with levofloxacin (500 mg daily for two weeks at first and then 250 mg daily in the next four weeks), and the other group with azithromycin (500 mg daily in the first two weeks and then with a dose of 250 mg daily for the next four weeks) for 6 weeks. The pulmonary function tests were performed and analyzed at the beginning of the study, two, four, and six weeks after the intervention.

The mean expiratory volume in the first second (FEV1) and the percentage of oxygen saturation (O2Sat) in the levofloxacin group and the azithromycin group were not significantly different at the beginning of the study. Importantly, six weeks after the initiation, the mean FEV1 (61.02±8.54% vs. 56.88±7.13%, p=0.029) and O2Sat (91.00±1.72% vs. 85.44±1.77%, p=0.001) in the levofloxacin group were significantly higher than those in the azithromycin group.

The present study showed that the favorable effect of six-week therapy with levofloxacin compared to azithromycin can significantly increase the pulmonary values of FEV1 and O2Sat in patients with exacerbated bronchiectasis.

Extrapyramidal symptoms (EPS) that include akathisia, dystonia, pseudoparkinsonism, and dyskinesia are abnormal movements commonly induced by antipsychotic medications. These symptoms are also associated with specific non-antipsychotic agents. This case report describes a case of a 9-year-old boy on antibiotics treatment that developed EPS. A 9-year-old boy presented to the emergency department of Imam Hossein Children›s Hospital with chief complaints of trismus, difficulty speaking, and tongue protrusion. One week before these presentations, he had been prescribed Tavanex® (levofloxacin) and clindamycin. His symptoms improved after the withdrawal of antibiotics and administering Biperiden, and he was discharged in good condition. On a follow-up visit one week after discharge, no remaining symptoms were present, and he was in good condition. Based on the questions in the Naranjo criteria, levofloxacin receives a score of 7 and is a probable cause of adverse drug reaction (ADR). Clindamycin, with a score of 6, is also a probable cause for this adverse drug reaction, but clinical judgment was in favor of levofloxacin as the culprit. Clinicians should be aware of the potential EPS of levofloxacin at standard doses. Effective management of adverse events is necessary to ensure patient safety and optimal outcomes

Stenotrophomonas maltophilia is an opportunistic pathogen causing nosocomial infections. Diclofenac is an anti-inflammatory drug that is considered a non-antibiotic drug. This study assessed the antibacterial and antibiofilm effects of diclofenac and levofloxacin/diclofenac combination against levofloxacin resistant isolates.

Minimum inhibitory concentration was determined using broth microdilution method for levofloxacin, diclofenac, and levofloxacin/diclofenac combination. Biofilm forming capacity and biofilm inhibition assay were determined. Relative gene expression was measured for efflux pump genes; smeB, and smeF genes and biofilm related genes rmlA, spgM, and rpfF without and with diclofenac and the combination.

Diclofenac demonstrated MIC of 1 mg/ml. The combination-with ½ MIC diclofenac- showed synergism where levofloxacin MIC undergone 16-32 fold decrease. All the isolates that overexpressed smeB and smeF showed a significant decrease in gene expression in presence of diclofenac or the combination. The mean percentage inhibition of biofilm formation with diclofenac and the combination was 40.59% and 46.49%, respectively. This agreed with biofilm related genes expression investigations.

Diclofenac showed an antibacterial effect against Stenotrophomonas maltophilia. The combination showed in-vitro synergism, significant reduction in biofilm formation and in the relative level of gene expression. Furthermore, it can potentiate the levofloxacin activity or revert its resistance.

 The emergence of antibiotic-resistant bacteria poses a significant global concern. The improper use of antibiotics, identified as a leading contributor to this problem, is a widespread issue in medical centers worldwide.

 This study aimed to investigate the utilization pattern of levofloxacin, a commonly prescribed antibiotic.

 We conducted a retrospective descriptive study in Ahvaz, Iran, focusing on patients who had received levofloxacin over a 6-month period. Data collection involved a questionnaire comprising patient demographic details, diagnosis information, details concerning levofloxacin administration, and outcomes, all extracted from the patients' medical records. During the assessment, we considered factors such as the correct dosage, frequency of administration, potential drug interactions, and adverse effects. Data analysis was performed using SPSS v. 20.

 A total of 35 patients, with a mean age of 55.17 ± 20.36 years, received levofloxacin during the study period, and 48.6% of them were women. On average, each patient received 3.20 ± 2.85 grams of levofloxacin, with a minimum dose of 0.500 grams and a maximum of 11.50 grams. The average treatment duration was 3.813 ± 4.26 days. In only 8.6% of cases, the prescribed dosage was deemed inappropriate, while in 40% of cases, the duration of antibiotic use was found to be inadequate.

 The utilization of levofloxacin was deemed irrational in 40% of cases. Although the prescribed dosage for the respective diagnoses was generally accurate, the treatment duration was often incorrect, potentially contributing to antibiotic resistance.

In our work, a process for levofloxacin (LVO) digestion using the microwave digester was proposed. Simultaneous examination of fourteen metal elemental impurities (lithium, vanadium, chromium, manganese, iron, cobalt, nickel, copper, arsenic, molybdenum, cadmium, antimony, mercury, and lead) in digested LVO sample was done by ICP-MS system. Quantification limits vary between 2.7 ppb to 3000 ppb for all studied metal elemental impurities.  Linear regression analysis proved linearity from LOQ quantity level to 200% of respective metal specification quantity limitations. The slope and coefficient correlation findings for fourteen metal elemental impurities were reported to be within permissible limit values. These outcomes demonstrated that the recommended ICP-MS methodology is capable of detecting 14 metal elemental impurities. Percentage recoveries for all studied metal elemental impurities were revealed to be satisfactory with recommended ICP-MS methodology conditions. The fully validated ICP-MS technique was finally adopted for batch studies of six different LVO parenteral for the selected fourteen metal elemental impurities.

The current study aims to compare the effectiveness of pre-urodynamic single-dose levofloxacin and post-urodynamic levofloxacin for three days related to the incidence of urinary tract infections post-urodynamic examination.

This is a single-blind randomized clinical trial conducted in three outpatient urology centers in Jakarta: Cipto Mangunkusumo General Hospital, Siloam Asri Hospital, and Persahabatan General Hospital using a consecutive sampling method between July 2019 - February 2022. The outcome of the study is the incidence of urinary tract infections in both treatment groups. Urinary tract infection was defined as a patient with one or more clinical symptoms of lower urinary tract infection and one or more urinalysis parameters positive for urinary tract infections.

A total of 126 patients (63 patients in each arm) were included in the evaluation and analysis. Overall, urinary tract infections were detected in 25 cases (19.8%), 12 patients from the pre-urodynamic antibiotic group (9.5%), and 13 patients from the post-urodynamic antibiotic group (10.3%) (P = .823). E.coli was the most common bacteria found in the urine culture.

There is no significant difference between a single dose of 500 mg of Levofloxacin administered one hour before the urodynamic study and a once-daily dose of 500 mg of Levofloxacin for three days following the urodynamic study related to urinary tract infections prevention post-urodynamic examination.

The ideal combination regimen for Helicobacter pylori (HP) eradication has not yet been determined and the success rate of HP eradication has been extensively reduced worldwide due to increasing antibiotic resistance. So this multinational multi-center randomized controlled trial was designed to evaluate the efficacy of tetracycline +levofloxacin for HP eradication.

During a 6-month period, all of the cases with HP infection in eight referral tertiary centers of three countries were included and randomly allocated to receive either tetracycline + levofloxacin or clarithromycin plus amoxicillin quadruple regimen for two weeks. For all of the participants, pantoprazole was continued for 4 more weeks and after one to two weeks of off-therapy, they underwent urea breath test C13 to prove eradication.

Overall 788 patients were included (358 male (45.4%), average age 44.2 years). They were diagnosed as having non-ulcer dyspepsia (516 cases, 65.5%), peptic ulcer disease (PUD) (234 cases, 29.69%), and intestinal metaplasia (38 cases, 4.8%). Racially 63.1% were Caucasian, 14.5% Arab, 15.6% African, and 6.1% Asian. The participants were randomly allocated to groups A and B to receive either tetracycline + levofloxacin or clarithromycin. Among groups A and B in intention to treat (ITT) and per protocol (PP) analysis, 75.2% & 82.1% (285 cases) and 67.5% & 70.1% (276 cases) of participants achieved eradication, respectively (P = 0.0001). The complete compliance rate in groups A and B were 84.4% and 83.6%, respectively. During the study, 33.5% of the participants in group A (127 cases) reported side effects while the complication rate among group B was 27.9% (114 cases, P = 0.041). The most common complaints among groups A and B were nausea and vomiting (12.6% & 9.3%) and abdominal pain (4.48% & 2.68%), respectively. The rate of severe complications that caused discontinuation of medication in groups A and B were 2.1% and 1.46%, respectively (P = 679). In subgroup analysis, the eradication rates of tetracycline+levofloxacin among patients with non-ulcer dyspepsia, PUD, and intestinal metaplasia were 79.4%, 88.1%, and 73.9%, respectively. These figures in group B (clarithromycin base) were 71.3%, 67.6%, and 61.5% respectively (P = 0.0001, 0.0001, and 0.043).

Overall, the combination of tetracycline+levofloxacin is more efficient for HP eradication in comparison with clarithromycin+amoxicillin despite more complication rate. In areas with a high rate of resistance to clarithromycin, this therapeutic regimen could be an ideal choice for HP eradication, especially among those who were diagnosed with PUD.

The treatment of ventilator-associated pneumonia (VAP) caused by carbapenemresistant Acinetobacter baumannii (CRAB) is still a great challenge. This study evaluated the effectiveness of the colistin/levofloxacin regimen compared to the usual colistin/meropenem regimen in the treatment of patients with VAP caused by CRAB.

Experimental approach: 

The patients with VAP were randomly assigned to experimental (n = 26) and control (n = 29) groups. The first group received IV colistin 4.5 MIU every 12 h + levofloxacin 750 mg IV daily, and the second group received IV colistin with the same dose + meropenem 1 g IV every 8 h for 10 days. The clinical (complete response, partial response, or treatment failure) and microbiological responses at the end of the intervention were recorded and compared between the two groups.

The complete response rate was higher (n = 7; 35%) and the failure rate was lower (n = 4; 20%) in the experimental group than in the control group (n = 2; 8%, and n = 11; 44%, respectively), but the differences were not statistically significant. Even though the microbiological response rate was higher in the experimental group (n = 14; 70%) than in the control group (n = 12; 48%), the difference was not statistically significant. The mortality rate was 6 (23.10%) and 4 patients (13.8%) in the experimental and control groups, respectively (P = 0.490).

Conclusion and implication: 

The levofloxacin/colistin combination can be considered an alternative regimen to meropenem/colistin in the treatment of VAP caused by CRAB.

 Intestinal absorption of levofloxacin (LFX) is decreased by the concomitant administration of antacids due to the formation of insoluble chelate complexes with various metal cations.

 The following four ester prodrugs of LFX—cilexetil ester (LFX-CLX), medoxomil ester (LFX-MDX), ethoxycarbonyl 1-ethyl hemiacetal ester (LFX-EHE) and pivaloyloxymethyl ester (LFX-PVM)—were synthesized. Then, the lipophilicity, in vitro chelate formation with aluminum chloride (AlCl3), chemical and enzymatic stability, minimum inhibitory concentrations (MICs) against some bacteria, and the efficacy in preventing chelate formation of prodrugs with aluminum hydroxide (Al(OH)3) in rabbits were evaluated.

 The synthesized ester prodrugs of LFX exhibited high purity and higher lipophilicities than LFX depending on the ester moieties. MICs of the prodrugs against S. aureus, E. coli, and P. aeruginosa were more than 10 times higher than those of LFX. Prodrugs were stable chemically but unstable enzymatically and generated LFX in biological specimens. When AlCl3 solution was mixed with LFX solution in vitro, insoluble chelate complex was formed immediately. In rabbits, co-administration of Al(OH)3 with LFX reduced the oral bioavailability of LFX by approximately 40%. In contrast, no precipitation was observed when AlCl3 solution was mixed with each prodrug solution in vitro, and co-administration of Al(OH)3 exerted no significant effect on the oral bioavailability of LFX when each prodrug was administered in rabbits.

 The ester prodrug approach of LFX could be a feasible strategy for avoiding chelate formation with aluminum ion in vivo.

Long-term use of levofloxacin can cause alterations in the liver function. This study aimed to determine the protective effect of black seed oil (BSO) against liver injury due to levofloxacin administration in rats.

The chemical composition of BSO was analyzed with gas chromatography and mass spectrophotometry (GC-MS). Rats (n=30) were treated daily with levofloxacin and BSO at three doses (1, 2 or 4 mL/kg) orally for 28 days. The presence of liver injury was determined based on serum biomarkers and liver malondialdehyde (MDA) levels, and histopathological examinations. 

The GC-MS analyses showed that BSO contained 25 chemical compounds, including thymoquinone (10.14%). The levofloxacin administration significantly increased the liver enzymes and MDA levels, and induced a marked alteration in the liver histological structures. Treatments of rats with one or two mL/kg BSO significantly decreased the liver enzymes, and MDA levels compared to those that received levofloxacin alone (P<0.05). However, the highest dose (4 mL/kg) BSO failed to improve liver MDA levels. The recovery of liver histological damages was also observed in rats treated with BSO. 

It was concluded that the BSO administration reduced the liver dysfunction due to levofloxacin at doses of 1 or 2 mL/kg, but not at 4 mL/kg. Further research is warranted to explore if the protective effect of BSO is associated with its antioxidant properties.

Levofloxacin is a fluoroquinolone antibiotic with extensive anti-bacterial effects.Levofloxacin is widely used for treatment of urinary and vaginal infections.

This research surveyed the cytotoxicity effects of levofloxacin on ovarian follicles of mice in both in vitroand in vivoconditions, as well as its anticancer effect on human ovarian cancer cell line (SKOV3).

For in vitrostudy, the ovaries of animals were isolated and treated with levofloxacin at doses of 1, 2, 5, and 10 μg/ml for 6 days. For in vivostudy, animals were treated with levofloxacin at concentrations of 100, 200, 400, and 800 mg/kg for 24 days. Histopathological and morphological examinations of ovarian tissues were performed. Real-time PCR and Western Blot techniques were performed to analyze apoptosis-related genes and proteins of ovarian tissues.

Levofloxacin at higher concentrations caused morphological changes and remarkably decreased the number of primary, secondary, and adult follicles compared to the control group. The percentage of viable SKOV3 cells was 10.12%, 7.63%, and 2.17% following exposure to levofloxacin (at a concentration of 800 μg/ml) for 24, 48, and 72 h, respectively.The half-maximal inhibitory concentration of levofloxacin against SKOV3 was found to be 181.1, 74.84, and 27.58 μg/ml at 24, 48, and 72 h, respectively. The percentage of SKOV3 cells apoptosis following exposure to levofloxacin after 72 h at 20, 80, and 200 μg/ml doses was 11%, 42%, and 52%, respectively. Real-time PCR revealed up-regulation of Baxand Caspase-3genes after exposure to levofloxacin in SKOV3 cells, whereas the expression of Bcl2was significantly decreased in a concentration-depended manner.

The present study demonstrates that levofloxacin induces apoptosis of both ovarian follicles and human ovarian cancer cell lines

Plasmid-mediated quinolone resistance (PMQR) determinants are commonly characterized in Klebsiella pneumoniae isolates worldwide and complicate the treatment of infections caused by this bacterium.

This study aimed to investigate the prevalence of PMQR determinants and molecular typing of blood isolates of K. pneumoniae in Milad hospital in Tehran, Iran, within 2018 - 2019.

A total of 100 K. pneumoniae isolates were tested for susceptibility to quinolones using the disk diffusion method. The minimum inhibitory concentrations (MICs) of ciprofloxacin (CIP) and levofloxacin (LEV) were determined using the microdilution broth method. The PMQR determinants were detected by polymerase chain reaction (PCR) assay, and the genetic relationship between the isolates was assessed using enterobacterial repetitive intergenic consensus (ERIC)-PCR.

The resistance rates of the isolates to LEV, CIP, nalidixic acid, and norfloxacin were determined to be 62%, 46%, 29%, and 23%, respectively. Eighty-one isolates were resistant to at least one tested quinolone. A high-level CIP and LEV resistance (MIC > 32 mg/L) was observed in 15 (18.51%) and 36 (44.44%) isolates, respectively. The PMQR genes were detected in 71 (87.65%) isolates. The oqxAB, qnrS, qnrD, qnrB, aac(6')-Ib-cr, qnrA, qepA, and qnrC genes were detected in 71 (87.65%), 30 (37%), 25 (30.8%), 24 (29.6%), 18 (22.2%), 17 (21%), 17 (21%), and 8 (9.9%) isolates, respectively. The ERIC-PCR revealed 64 genotypes among quinolone-resistant isolates.

The high prevalence of PMQR genes observed in this study is a significant concern for public health since they can contribute to the spread of fluoroquinolone resistance among clinical isolates. The ERIC-PCR revealed high heterogeneity among the studied isolates, indicating that they emerged from different sources.

We compared two common antibiotic regimens for the treatment of mild to moderate CAP: levofloxacin versus β-lactam and macrolide combination; in terms of their efficacy and side effects.

Patients with mild to moderate CAP were randomized into two groups. Group I received a combination of 1 gram ceftriaxone daily and 500 mg azithromycin daily for 5-7 days. Group II received levofloxacin 750 mg daily for five days. The signs and symptoms, hospitalization length, and the side effects were investigated.

There were 77 and 74 patients in groups I and II. The vital signs of group II were significantly better on the 3rd day of admission, except for the temperature (P=0.09). The O2 saturation of group II was markedly improved on the 5th day of admission (P=0.0061). In terms of clinical symptoms and hospitalization length, group II was considerably better. However, the rate of side effects in both groups was similar (P=0.885).

Hospitalized patients with mild to moderate CAP might take more advantage of fluoroquinolone administration. It could improve the patients' signs and symptoms and reduce hospitalization length, compared with the combination of macrolide and cephalosporin, with the same rate of side effects.

Levofloxacin is a fluoroquinolone antibiotic that has broad-spectrum antimicrobial activity, but it may induce kidney dysfunction. Clove oil (Oleum caryophylli) has antioxidant properties that may alleviate levofloxacin toxicity. This study aimed to examine the protective effect of clove oil on levofloxacin-induced nephrotoxicity in rat animal models.

A total of 24 male rats were divided into 6 groups. One group did not receive levofloxacin to serve as the control. The treatment groups received a single daily administration of levofloxacin (93 mg/kg) with either placebo or clove oil (10 mg/kg, 25 mg/kg, or 50 mg/kg per body weight) pre-treatment. Another group received Curcuma extract pre-treatment as a comparison. Blood samples were withdrawn after 28 days of treatment to measure serum biomarkers (urea and creatinine), and the kidneys were removed to measure renal Malondialdehyde (MDA) and histopathological analysis.

The results showed that clove oil pre-treatment at a dose of 10 mg/kg was able to reduce renal MDA and serum biomarker levels (P<0.05). The effect was similar to that found in Curcuma-treated rats. In addition, clove oil (10 mg/kg) was also found to ameliorate renal histopathological damage due to levofloxacin. 

Based on biomarker and histopathological analysis, clove oil pre-treatment in rats provides a nephroprotective effect against levofloxacin toxicity.

Glucose 6-Phosphate Dehydrogenase deficiency (G6PD) is an X-linked recessive disorder recognized as the most prevalent enzyme deficiency around the world. G6PD deficiency has a high prevalence in Iran, especially in the northern regions. As we know, hemolysis in G6PD patients was not reported with levofloxacin previously.

 In this report, we introduce a 54-year-old G6PD deficient woman who experienced the symptoms of hemolytic anemia following completion of treatment with levofloxacin.

After ruling out other causes of hemolysis, by using the Naranjo scale, levofloxacin was considered as a possible cause of hemolysis.

Though the hemolytic anemia induced by levofloxacin is extremely rare in G6PD deficient patients, drug-induced hemolytic anemia should be considered as one of the differential diagnoses. It would be appropriate to use an alternative antibiotic instead of levofloxacin in a G6PD deficient patient.

To determine the empirical usage of antibiotics and analyze the pathogen spectrum during the perioper-ative period of flexible ureteroscopic lithotripsy (FURSL) with a focus on levofloxacin.

This retrospective analysis included 754 patients who underwent FURSL successfully in our hospital from January 2015 to July 2019. All patients were sent for urine cultures and prescribed antibiotics during the perioperative period. Patients with negative preoperative urine cultures were divided into levofloxacin (LVXG) and non-levofloxacin groups (NLVXG) based on the empirical use of antibiotics. Operative time, the length of postoperative hospital stays and total hospital stays, total hospitalization costs, postoperative fever rate, and removal rate of stones were compared. Patients with positive urine cultures were analyzed for pathogen distri-bution and antibiotic resistance.

In the empirical use of antibiotics among 541 cases with negative urine cultures, the prescription rate of levofloxacin was 68.95%. Compared to that in NLVXG, LVXG had a lower cost of antibiotics but a higher post-operative fever rate and a longer hospital stay. There were no significant differences in operative time, the total hospitalization costs, and the removal rate of stones between the two groups. The top two common pathogens were Escherichia coli (36.11%) and Enterococcus faecalis (24.07%), with resistance rates of 74.36% and 71.15% to levofloxacin, respectively.

Levofloxacin might be no longer suitable as the first-line choice of clinical experience when perform-ing FURSL in some centers.

The prevalence of Helicobacter pylori (H. pylori) in developing countries is 50.8%, with the highest occurrence presented in Africa (79.1%). It increases the risk of chronic gastritis, peptic ulcer, cancer of the stomach, and lymphoma. The effect of standard
treatment for H. pylori eradication is below 80%, and evaluation of alternative lines of treatment is needed. We aimed to compare the hybrid, reverse hybrid, and levofloxacin quadruple therapies as first-line therapy in Egypt.

This was a randomized interventional trial done in the clinics affiliated with the Internal Medicine Department. 330 individuals were selected according to the inclusion criteria. They were divided into three groups: group 1 (110 subjects who received a reverse hybrid regimen), group 2 (110 subjects who received a hybrid regimen), and group 3 (110 subjects who received a non-bismuth levofloxacin quadruple regimen).

Group 3 had a significantly lower eradication rate of 82.7% versus 92.7% and 91.8% in groups 1 and 2, respectively. There were non-significant differences in the incidence rates of adverse events among the three groups.

Both the reverse hybrid and hybrid groups had good eradication rates in the Egyptian population, but non-bismuth levofloxacin quadruple therapy did not obtain a sufficient eradication rate.