From the FDA Drug Label
Levofloxacin has in vitro activity against Gram-negative and Gram-positive bacteria fections as described in Indications and Usage (1): Gram-PositiveBacteria Enterococcus faecalis Staphylococcus aureus (methicillin-susceptible isolates) Staphylococcus epidermidis (methicillin-susceptible isolates) Staphylococcus saprophyticus Streptococcus pneumoniae (including multi-drug resistant isolates [MDRSP] )1 Streptococcus pyogenes
The antibiotic levofloxacin is effective against Staphylococcus epidermidis in a urine culture, but only for methicillin-susceptible isolates 1.
From the Research
For Staphylococcus epidermidis in urine culture, vancomycin is the most effective antibiotic, especially in cases of methicillin resistance, as it provides reliable bactericidal activity against this microorganism 2. When considering treatment options, it's essential to prioritize the most recent and highest quality study, which in this case, is not directly provided for the specific context of Staphylococcus epidermidis in urine cultures. However, given the information available, vancomycin stands out as a critical option for methicillin-resistant strains, which are a concern in both historical and recent studies 2, 3. Some key points to consider in the treatment of Staphylococcus epidermidis infections include:
- The bacterium often carries resistance to multiple antibiotics, making susceptibility testing crucial for guiding treatment.
- S. epidermidis is typically a skin contaminant in urine cultures, so treatment is only warranted if there are significant colony counts (>100,000 CFU/mL), symptoms of urinary tract infection, or if the patient is immunocompromised.
- In complicated cases, such as catheter-associated infections, the choice of antibiotic may need to be adjusted based on the suspected or confirmed resistance pattern of the organism.
- Newer agents and some older ones show good activity against resistant staphylococci, including trimethoprim-sulfamethoxazole, ceftaroline, daptomycin, fosfomycin, linezolid, dalbavancin, televancin, and omadacycline 3. Given the potential for resistance and the severity of infections caused by Staphylococcus epidermidis, particularly in immunocompromised patients or those with catheter-associated infections, vancomycin remains a pivotal choice for treatment, especially when methicillin resistance is suspected or confirmed 2, 3.