From the Guidelines
For patients who have failed first-line therapy, the recommended second-line antibiotic treatment using levofloxacin or moxifloxacin is levofloxacin 500–750 mg PO once daily or moxifloxacin 400 mg PO once daily, as these fluoroquinolones may be used in patients with native vertebral osteomyelitis (NVO) due to Enterobacteriaceae and other susceptible aerobic gram-negative organisms 1. When considering second-line treatment, it's crucial to choose an antibiotic based on in vitro susceptibility, patient allergies, intolerances, and potential drug interactions or contraindications to a specific antimicrobial.
- The choice between levofloxacin and moxifloxacin should be guided by the specific causative pathogens and local resistance patterns.
- Dosage adjustments may be necessary based on patients’ renal and hepatic function.
- It's also important to note that these fluoroquinolones are not recommended for use in patients with staphylococcal NVO as monotherapy, highlighting the need for accurate diagnosis and targeted therapy 1.
- In cases where first-line therapy has failed, reevaluation of the patient and consideration of alternative treatments, including the use of levofloxacin or moxifloxacin, is essential to ensure effective management of the infection 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Second-Line Antibiotic Treatment
The use of levofloxacin or moxifloxacin as a second-line antibiotic treatment is considered for patients who have failed first-line therapy.
- Levofloxacin has been shown to be effective in the treatment of various bacterial infections, including community-acquired pneumonia (CAP), acute exacerbations of chronic bronchitis, and uncomplicated skin and skin structure infections 2, 3, 4, 5.
- The efficacy of levofloxacin in the treatment of CAP has been established, with clinical response rates ranging from 86 to 95% 2.
- A high-dose, short-course regimen of levofloxacin (750mg once daily for 5 days) has been approved for use in the US in the treatment of CAP, acute bacterial sinusitis, complicated urinary tract infections, and acute pyelonephritis 4, 5.
- Moxifloxacin has also been shown to be effective in the treatment of various bacterial infections, although the provided evidence primarily focuses on levofloxacin 2.
Dosage and Administration
- The recommended dosage of levofloxacin for the treatment of CAP is 500mg once daily for 10 days, although a high-dose, short-course regimen of 750mg once daily for 5 days has also been approved 4, 5.
- Levofloxacin can be administered orally or intravenously, with the option to switch between formulations 3, 4, 5.
- The choice of dosage and administration route may depend on the severity of the infection, the patient's weight, and other factors 6.
Considerations for Use
- Levofloxacin has a broad spectrum of activity against Gram-positive and Gram-negative bacteria, including penicillin-resistant Streptococcus pneumoniae 2, 3.
- The use of levofloxacin as a second-line antibiotic treatment should be considered carefully, taking into account the potential for resistance selection and the need to maintain its effectiveness against severe infections and penicillin- and macrolide-resistant pathogens 4.