What are the roles of levofloxacin and ofloxacin in intravenous-to-oral switch therapy?

Updated: Jul 30, 2018
  • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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The intravenous and oral formulations of levofloxacin have same-dose bioequivalence, allowing for switch or step-down therapy from parenteral to oral formulations of the same agent at the same dose. In the late 1990s, ofloxacin was also used for switch therapy, but its role is unclear in switch therapy because it is a twice-a-day medication, whereas levofloxacin is a once-a-day medication. Fluoroquinolones should not be used in children because of a possible adverse effect on cartilage.

Levofloxacin provides almost complete (≥99%) oral bioavailability, suggesting that oral administration may provide exposure that is comparable to that of the intravenous regimen. The overall clinical success rate in such a switch is 94.1%. In several randomized controlled trials, 5-14 days of treatment with intravenous and/or oral levofloxacin proved to be an effective therapy for patients with upper and lower respiratory tract infections. In patients with mild-to-severe community-acquired pneumonia (CAP), intravenous and/or oral levofloxacin at a dose of 500 mg once or twice daily was as effective as clarithromycin, azithromycin, and amoxicillin/clavulanic acid. Overall, clinical response rates with levofloxacin were 86-95% versus 88-96% with comparator agents; bacteriological response rates were 88-95% and 86-98%, respectively.

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