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Table of Contents
Vol. 46, Suppl. 1, 2000
Issue release date: May 2000
Chemotherapy 2000;46(suppl 1):6–14
(DOI:10.1159/000048487)

Pharmacodynamics and Pharmacokinetics of Levofloxacin

Nightingale C.H. · Grant E.M. · Quintiliani R.
Hartford Hospital, University of Connecticut School of Pharmacy, Hartford, Conn., USA

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Abstract

Principles of antibiotic pharmacodynamics include factors that are important for effective eradication of bacteria as well as the suppression of resistance. For effective eradication of bacteria and a good clinical outcome, a ratio for the area under the plasma concentration-time curve relative to the minimum inhibitory concentration (AUC/MIC) of greater than 100 is needed for gram-negative organisms, and a level of greater than 30 is required for gram-positive organisms. Pharmacodynamic principles can also be used to devise the optimal administration regimen for specific antimicrobial agents. Pharmacodynamic analysis of the activity of levofloxacin against Streptococcus pneumoniae revealed that, 99% of the time, actual hospitalized patients achieve an AUC/MIC of greater than 30. This indicates that levofloxacin will be very effective in treating S. pneumoniae infections in the majority of patients. Cost of treatment is an increasing concern voiced by healthcare providers and users alike. This has led to a much greater emphasis placed upon the cost of individual drugs used in the management of infections. However, when evaluating the cost of an antibiotic, it is extremely important that not only are the direct acquisition costs assessed, but consideration also given to other aspects incurring a financial burden, such as drug preparation cost, supplies, costs of treating adverse events or any treatment failures. It is only by having such a full assessment of costs that realistic financial comparisons can be made between different antibiotics.



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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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References

  1. Lacy MK, Lu W, Xu X, Tessier PR, Nicolau DP, Quintiliani R, Nightingale CH: Pharmacodynamic comparisons of levofloxacin, ciprofloxacin, and ampicillin against Streptococcus pneumoniae in an in vitro model of infection. Antimicrob Agents Chemother 1999;43:672–677.

    External Resources

  2. Lister PD, Sanders CC: Pharmacodynamics of levofloxacin and ciprofloxacin against Streptococcus pneumoniae. Br Soc Antimicrob Chemother 1999;43:79–86.
  3. Nightingale CH: Determining outcomes in respiratory tract infections: Pathogen, patient, and antibiotic properties. Infect Med 1999;(special suppl):37–40.
  4. Nicolau DP, Freeman CD, Belliveau PP, Nightingale CH, Ross JW, Quintiliani R: Experience with a once-daily aminoglycoside program administered to 2184 adult patients. Antimicrob Agents Chemother 1995;39:650–655.
  5. Grant EM, Quintiliani R: Application of Population Pharmacokinetics and Surveillance Data to Predict AUC/MIC Ratios: A Monte Carlo Analysis. American Society of Health-System Pharmacists Midyear Clinical Meeting, Orlando 1999.
  6. Preston SL, Drusano GL, Berman AL, Fowler CL, Chow AT, Dornseif B, Reichl V, Natarajan J, Wong FA, Corrado M: Levofloxacin population pharmacokinetics and creation of a demographic model for prediction of individual drug clearance in patients with serious community-acquired infection. Antimicrob Agents Chemother 1998;42:1098–1104.

    External Resources

  7. Thornsberry C, et al: Tracking Resistance in the United States Today, 1998-1999 (TRUST III report). San Francisco, ICAAC, 1999.
  8. Richerson MA, Ambrose PG, Quintiliani R, Bui K, Nightingale CH: Pharmacoeconomic evaluation of alternative antibiotic regimens in hospitalized patients with community-acquired pneumonia. Infect Dis Clin Pract 1998;7:227–233.


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