[Role of levofloxacin in the treatment of urinary tract infections]

Abstract

The treatment of urinary tract infections (UTIs) and prostatitis has to be tailored on the clinical features of patients. UTIs should be differentiated in uncomplicated UTIs, acute pyelonephritis, complicated UTIs and UTIs in men, and asymptomatic UTIs. Prostatic inflammatory disease can be divided in 5 categories. Uncomplicated UTIs should be treated with a 3-day course of oral antibiotics, pyelonephritis and complicated UTIs with a 14-day course of oral antibiotics. In the case of high fever with chills intensive treatment with an appropriate antibiotic administered intravenously is needed until subsidence of the acute symptoms. This should be followed by oral antibiotic for two weeks. The treatment of asymptomatic UTIs should be considered for children and pregnant women. Antibiotics should be administered for 14-42 days in category I to IIIA of inflammatory prostatic disease. In the last decade acquired resistance of uropathogens to aminopenicillins and trimethoprim-sulfamethoxazole appears to have been increasing in the United States and Europe, while the susceptibility to systemic fluoroquinolones has remained unchanged at 98-99%. Particularly levofloxacin showed activity against Gram-positive bacteria without loss of Gram-negative spectrum. In normal adults levofloxacin reached urinary, bladder and prostate concentrations after a 250 mg oral dose above the MIC90 for all typical uropathogens. Multicenter clinical studies on clinical and microbiological efficacy of levofloxacin were carried out in the treatment of genitourinary tract infections. Levofloxacin 250 mg once daily for three days was highly effective in the treatment of uncomplicated UTIs. Levofloxacin 250 mg once daily for 7-10 days was clinically and microbiologically effective also for the treatment of acute pyelonephritis and complicated UTIs. In patients with nonchlamydial chronic prostatitis the bacteriological response was 85.4%. Finally levofloxacin showed a superior tolerability profile than other fluoroquinolones.