levofloxacin

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.

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.