Is it okay to prescribe Levofloxacin (levofloxacin) to a patient with prostatitis symptoms and a history of colitis (inflammatory bowel disease)?

From the Guidelines

Prescribing levofloxacin to a patient with prostatitis symptoms who has a history of colitis is not recommended due to the risk of triggering or exacerbating colitis, particularly if the patient has had Clostridioides difficile infection (CDI). According to the American Gastroenterological Association institute guideline on the medical management of microscopic colitis 1, the use of antibiotics such as levofloxacin should be approached with caution in patients with a history of colitis. The guideline recommends the use of budesonide for induction and maintenance therapy in patients with microscopic colitis, and suggests against the use of probiotics or other alternative therapies.

For prostatitis, alternative antibiotics such as trimethoprim-sulfamethoxazole (TMP-SMX) at a dose of 160/800 mg twice daily for 4-6 weeks would be a better first-line option. The Centers for Disease Control and Prevention (CDC) guidelines for the treatment of sexually transmitted diseases, including prostatitis, recommend the use of fluoroquinolones such as levofloxacin, but also note the importance of considering the patient's medical history and potential risks 1.

In this case, the risk of triggering a colitis flare with levofloxacin outweighs the potential benefits of treating prostatitis, and alternative antibiotics should be considered. Before prescribing any antibiotic, it's essential to confirm the diagnosis with appropriate cultures if possible, assess the severity and type of previous colitis, and consider consulting with gastroenterology if the colitis history is significant. The benefit of treating prostatitis must be weighed against the risk of triggering a colitis flare, which could lead to significant morbidity for the patient.

Some studies, such as the guideline on antimicrobial therapy of sexually transmitted diseases in Taiwan 1, recommend the use of levofloxacin for the treatment of gonococcal urethritis, but this does not apply to patients with a history of colitis. In general, the use of fluoroquinolones such as levofloxacin should be approached with caution in patients with a history of colitis, and alternative antibiotics should be considered to minimize the risk of triggering or exacerbating colitis.

From the FDA Drug Label

1.8 Chronic Bacterial Prostatitis Levofloxacin tablets are indicated for the treatment of chronic bacterial prostatitis due to Escherichia coli, Enterococcus faecalis, or methicillin-susceptible Staphylococcus epidermidis [see Clinical Studies (14.6)]. 14.6 Chronic Bacterial Prostatitis Adult patients with a clinical diagnosis of prostatitis and microbiological culture results from urine sample collected after prostatic massage (VB3) or expressed prostatic secretion (EPS) specimens obtained via the Meares-Stamey procedure were enrolled in a multicenter, randomized, double-blind study comparing oral levofloxacin 500 mg, once daily for a total of 28 days to oral ciprofloxacin 500 mg, twice daily for a total of 28 days.

Levofloxacin is indicated for the treatment of chronic bacterial prostatitis. However, there is no information in the drug label about the safety of levofloxacin in patients with a history of colitis. Therefore, it is not possible to determine whether it is ok to prescribe levofloxacin to a patient with prostatitis symptoms and a history of colitis based on the provided drug label 2.

From the Research

Considerations for Prescribing Levofloxacin

• The patient's history of colitis is a significant consideration when prescribing antibiotics, as some antibiotics can exacerbate or trigger colitis symptoms.
• There is no direct evidence in the provided studies that addresses the safety of prescribing levofloxacin to a patient with prostatitis symptoms and a history of colitis.
• However, levofloxacin has been shown to be effective in treating chronic bacterial prostatitis (CBP) in several studies 3, 4.
• The studies suggest that levofloxacin is well tolerated and has a high clinical success rate in treating CBP, with a clinical success rate of 92% at 5-12 days post-treatment 3.
• It is essential to weigh the potential benefits of prescribing levofloxacin against the potential risks, particularly in patients with a history of colitis.

Alternative Treatment Options

• Other antibiotics, such as trimethoprim-sulfamethoxazole, doxycycline, and minocycline, have been used to treat CBP, but their effectiveness and safety in patients with a history of colitis are not well established in the provided studies 5, 6.
• The choice of antibiotic should be based on the patient's specific needs and medical history, as well as the suspected or confirmed causative organism of the prostatitis.

Monitoring and Follow-up

• Patients with a history of colitis who are prescribed levofloxacin or other antibiotics should be closely monitored for signs of colitis exacerbation or other adverse effects.
• Regular follow-up appointments and laboratory tests, such as urine cultures and prostate-specific antigen (PSA) levels, may be necessary to assess the effectiveness of treatment and potential side effects 4, 7.