From the Guidelines
Levaquin (levofloxacin) is a recommended antibiotic for treating pyelonephritis, with a standard dosage of 750 mg once daily for 5 days, as long as the prevalence of fluoroquinolone resistance is not known to exceed 10% 1. The treatment of pyelonephritis requires careful consideration of the causative organism and local resistance patterns. According to the European Association of Urology guidelines, levofloxacin is an appropriate choice for empirical oral antimicrobial therapy for uncomplicated pyelonephritis, with a daily dose of 750 mg and a therapy duration of 5 days 1. Some key points to consider when prescribing Levaquin for pyelonephritis include:
- The patient should have a urine culture and susceptibility test performed to guide therapy 1
- The prevalence of fluoroquinolone resistance should be considered, and an initial intravenous dose of a long-acting parenteral antimicrobial may be necessary if resistance is suspected to exceed 10% 1
- Patients should be advised to complete the full course of antibiotics, even if symptoms improve before finishing, and to stay hydrated and avoid excessive sun exposure while taking the medication
- Common side effects of Levaquin include nausea, diarrhea, headache, and dizziness, and patients should be warned about the risk of tendon damage and advised to stop the medication and contact their doctor if they experience tendon pain or swelling.
From the FDA Drug Label
11 Acute Pyelonephritis: 5 or 10 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of acute pyelonephritis caused by Escherichia coli, including cases with concurrent bacteremia [see Clinical Studies (14.7,14.8)].
7 Complicated Urinary Tract Infections and Acute Pyelonephritis: 5 Day Treatment Regimen To evaluate the safety and efficacy of the higher dose and shorter course of levofloxacin, 1109 patients with cUTI and AP were enrolled in a randomized, double-blind, multicenter clinical trial conducted in the U.S. from November 2004 to April 2006 comparing levofloxacin 750 mg I. V. or orally once daily for 5 days (546 patients) with ciprofloxacin 400 mg I. V. or 500 mg orally twice daily for 10 days (563 patients).
Levaquin (levofloxacin) is indicated for the treatment of acute pyelonephritis. The recommended treatment regimen is 5 or 10 days. In a clinical trial, levofloxacin 750 mg orally once daily for 5 days was compared to ciprofloxacin 400 mg I.V. or 500 mg orally twice daily for 10 days in patients with complicated urinary tract infections and acute pyelonephritis 2.
From the Research
Efficacy of Levaquin for Pyelonephritis
- Levaquin (levofloxacin) has been shown to be effective in the treatment of acute pyelonephritis, with high-dose (750 mg) short-course therapy being a reasonable option for patients eligible for outpatient management 3, 4.
- Studies have demonstrated that levofloxacin has a broad spectrum antibacterial profile, allowing for monotherapy in patients with pyelonephritis, and has good tissue penetration and adequate concentration in the urinary tract to treat uropathogens 3, 5.
- Clinical trials have reported clinical success rates of 83-95% for levofloxacin in the treatment of pyelonephritis, with relatively low rates of adverse events 6, 5.
Comparison to Other Antibiotics
- Levofloxacin has been compared to other antibiotics, such as ciprofloxacin and lomefloxacin, in the treatment of pyelonephritis, and has been shown to have similar or superior efficacy and safety profiles 7, 5.
- A systematic review of randomized clinical trials found that levofloxacin was one of the oral antibiotics with comparable clinical success rates for the treatment of pyelonephritis, along with cefaclor and norfloxacin 6.
Safety and Tolerability
- Levofloxacin has been reported to be generally well tolerated, with low rates of adverse events and drug-related adverse events 3, 7, 5.
- However, the emergence of fluoroquinolone resistance has prompted re-examination of the use of levofloxacin as a first-line empirical treatment for pyelonephritis, particularly in areas with high resistance rates 4.