From the Guidelines
Levofloxacin is effective against E. coli, but its use should be guided by local resistance patterns and susceptibility testing, as resistance rates can be high. According to a study published in the Clinical Infectious Diseases journal in 2010 1, levofloxacin was compared to ciprofloxacin in a multicenter, double-blind, randomized, noninferiority study involving 619 patients with acute pyelonephritis or complicated UTI. The study found that microbiologic eradication rates were similar between the two groups (80% vs 80%), but among catheterized patients, the microbiologic eradication rate was higher in the levofloxacin group (79%) than it was in the ciprofloxacin group (53%).
Key Considerations
- The study suggests that a 5-day regimen with levofloxacin may be sufficient for most patients with mild CA-UTI 1.
- However, local antimicrobial resistance patterns should be considered when choosing empirical treatment, and regimens should be adjusted based on culture and susceptibility results 1.
- Shorter durations of treatment are preferred in appropriate patients to limit the development of resistance 1.
Treatment Approach
- For uncomplicated urinary tract infections caused by E. coli, alternative antibiotics like nitrofurantoin, fosfomycin, or trimethoprim-sulfamethoxazole may be preferred first-line options to help preserve fluoroquinolone effectiveness for more serious infections.
- Levofloxacin may be considered for complicated UTIs or systemic infections, but its use should be guided by local resistance patterns and susceptibility testing.
From the FDA Drug Label
Levofloxacin tablets are indicated for the treatment of nosocomial pneumonia due to methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, or Streptococcus pneumoniae. Levofloxacin tablets are indicated for the treatment of chronic bacterial prostatitis due to Escherichia coli, Enterococcus faecalis, or methicillin-susceptible Staphylococcus epidermidis. Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis. Levofloxacin tablets are indicated for the treatment of acute pyelonephritis caused by Escherichia coli, including cases with concurrent bacteremia. Levofloxacin tablets are indicated for the treatment of uncomplicated urinary tract infections (mild to moderate) due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus.
Yes, levofloxacin covers E. coli for various infections, including:
- Nosocomial pneumonia
- Chronic bacterial prostatitis
- Complicated urinary tract infections
- Acute pyelonephritis
- Uncomplicated urinary tract infections 2
From the Research
Levofloxacin Coverage of E. coli
- Levofloxacin has been shown to be effective against E. coli in various studies 3, 4, 5, 6, 7.
- The susceptibility of E. coli to levofloxacin can vary, with some studies reporting a mean susceptibility rate of 75.9% 3 and others reporting a susceptibility rate of 76% 7.
- High-dose levofloxacin (750 mg and 1000 mg) has been shown to produce early and prolonged bactericidal activity against fluoroquinolone-resistant strains of E. coli 5.
- The minimum inhibitory concentration (MIC) of levofloxacin against E. coli can range from <0.06 to 4 mg/L, with an MIC90 of 1-4 mg/L 4.
- Levofloxacin has been shown to be effective in treating urinary tract infections (UTIs) caused by E. coli, including those with fluoroquinolone resistance 3, 5, 6.
Factors Affecting Levofloxacin Coverage of E. coli
- The presence of efflux pump genes, such as acrA and acrB, can affect the susceptibility of E. coli to levofloxacin 7.
- The distribution of outer membrane porins, such as ompF and ompC, can also impact the effectiveness of levofloxacin against E. coli 7.
- The use of high-dose levofloxacin may be necessary to achieve optimal bactericidal activity against fluoroquinolone-resistant strains of E. coli 5.