Is Levofloxacin effective for treating sinusitis?

From the Guidelines

Levofloxacin is effective for treating sinusitis, particularly in cases where first-line antibiotic therapy has failed or in situations where major complications are likely, such as frontal, fronto-ethmoidal, or sphenoidal sinusitis.

Key Points

• According to the therapeutic outcomes model, levofloxacin has a predicted clinical efficacy of 90-92% for adult patients with sinusitis 1.
• The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 suggests that fluoroquinolones, including levofloxacin, can be used as an alternative to first-line antibiotics in certain cases of sinusitis 1.
• A study published in Pediatrics in 2011 lists levofloxacin as an effective therapy for acute otitis media and sinusitis, with Streptococcus pneumoniae and Haemophilus influenzae as primary pathogens 1.
• The French guidelines for systemic antibiotic treatment in upper and lower respiratory tract infections recommend levofloxacin as a second-line treatment for acute sinusitis, particularly in cases where first-line antibiotics are not effective 1.
• In patients with cystic fibrosis, levofloxacin can be used to treat sinusitis, especially in older children who require coverage for Pseudomonas aeruginosa 1.

From the FDA Drug Label

Levofloxacin is approved for the treatment of acute bacterial sinusitis (ABS) using either 750 mg by mouth x 5 days or 500 mg by mouth once daily x 10 to 14 days To evaluate the safety and efficacy of a high dose short course of levofloxacin, 780 outpatient adults with clinically and radiologically determined acute bacterial sinusitis were evaluated in a double-blind, randomized, prospective, multicenter study comparing levofloxacin 750 mg by mouth once daily for five days to levofloxacin 500 mg by mouth once daily for 10 days Clinical success rates (defined as complete or partial resolution of the pre-treatment signs and symptoms of ABS to such an extent that no further antibiotic treatment was deemed necessary) in the microbiologically evaluable population were 91.4% (139/152) in the levofloxacin 750 mg group and 88.6% (132/149) in the levofloxacin 500 mg group at the test-of-cure (TOC) visit (95% CI [-4. 2,10] for levofloxacin 750 mg minus levofloxacin 500 mg)

Levofloxacin is effective for treating sinusitis. The clinical success rates for levofloxacin in the treatment of acute bacterial sinusitis were 91.4% for the 750 mg group and 88.6% for the 500 mg group 2.

From the Research

Efficacy of Levofloxacin in Treating Sinusitis

• Levofloxacin has been shown to be effective in treating acute bacterial sinusitis, with a clinical success rate of 88% and a microbiologic eradication rate of 92% 3.
• The most common pathogens involved in sinusitis, such as Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, and Moraxella catarrhalis, were effectively eradicated by levofloxacin, with eradication rates ranging from 93% to 100% 3.
• Levofloxacin has also been found to be effective in treating sinusitis with a high risk of complications, with a clinical success rate of 94.1% and a consistent success rate according to the localization of the infection and the various pathogens involved 4.

Penetration of Levofloxacin into Paranasal Sinuses Mucosa

• A study found that levofloxacin penetrates well into paranasal sinuses mucosa, with median mucosal concentrations of 0.96 mg/l at 1 hour, 2.50 mg/l at 2 hours, and 5.84 mg/l at 3 hours after a single 500 mg oral dose 5.
• The average paranasal sinuses mucosa-to-plasma ratios increased from 1.46 at 1 hour to 1.81 at 2 hours and to 2.56 at 3 hours, indicating that levofloxacin achieves high levels in excess of plasma concentrations in the sinonasal tissue 5.

Comparison with Other Antibiotics

• Levofloxacin has been compared to other antibiotics, such as amoxicillin/clavulanic acid, cefuroxime axetil, and cefaclor, and has been found to be similar in efficacy in treating acute maxillary sinusitis 6.
• Levofloxacin has also been found to be effective in treating other respiratory tract infections, such as community-acquired pneumonia and acute exacerbations of chronic bronchitis, with clinical success rates of 87-96% and bacteriological eradication rates of 87-100% 6.