Pharmacodynamics of Levofloxacin in Patients With Acute Exacerbation of Chronic Bronchitis

• Published in: Chest Vol. 128; no. 4; pp. 2093 - 2098
• Main Authors: Cazzola, Mario, Matera, Maria Gabriella, Donnarumma, Giovanna, Tufano, Maria Antonietta, Sanduzzi, Alessandro, Marchetti, Federico, Blasi, Francesco
• Format: Journal Article
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.10.2005; American College of Chest Physicians
• Subjects: Acute Disease; acute exacerbations of chronic bronchitis; Aged; Anti-Bacterial Agents - blood; Anti-Bacterial Agents - pharmacokinetics; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Area Under Curve; Biological and medical sciences; Bronchitis - drug therapy; Cardiology. Vascular system; Chronic obstructive pulmonary disease, asthma; Disease Progression; Female; Forced Expiratory Volume; Humans; Levofloxacin; Male; Medical sciences; Middle Aged; Ofloxacin - blood; Ofloxacin - pharmacokinetics; Ofloxacin - therapeutic use; pharmacodynamics; pharmacokinetics; Pharmacology. Drug treatments; Pneumology; Predictive Value of Tests; Smoking; Sputum - chemistry; Cmax; levofloxacin; pharmacodynamics; CI; MIC; pharmacokinetics; AUC0–24; acute exacerbations of chronic bronchitis; Human; Levofloxacin; Respiratory disease; Acute; Cardiovascular disease; Patient; Chronic; Bronchus disease; Bronchitis; Antibacterial agent; Pharmacokinetics
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.128.4.2093

Levofloxacin is a fluoroquinolone antimicrobial agent for which pharmacodynamic relationships between the maximum serum antibiotic concentration (Cmax)/minimum inhibitory concentration (MIC) ratio and/or the area under the serum concentration-time curve during a 24-h dosing period (AUC0–24)/MIC ratio and clinical and/or microbiological outcomes have been developed. In this study we examined the relationship between the in vitro bacterial susceptibility to levofloxacin, the achieved levofloxacin serum and sputum concentrations, and the in vivo bacterial eradication in patients with acute exacerbations of chronic bronchitis. Thirty patients received levofloxacin, 500 mg/d po for 7 days. Samples of venous blood and sputum for the determination of levofloxacin concentrations were collected on day 1 immediately prior to dosing, and then at 1, 4, 8, 12, and 24 h. The mean peak concentration in serum (6.5 mg/L) was found 1 h after administration, and at 4 h after administration in sputum (5.1 mg/L). Levofloxacin was always detectable 24 h after administration from both samples. Successful treatment occurred in 90% (27 of 30 patients) when assessed both clinically and bacteriologically. Treatment was successful in eight patients when the AUC0–24/MIC ratio was > 40 for serum, and in nine patients when it was > 30 for sputum. Treatment was also successful in seven patients when the Cmax/MIC ratio was > 5.01 for serum, and in nine patients when the Cmax/MIC ratio was > 4.01 for sputum. Treatment was successful in 90% (27 of 30 patients) when the AUC0–24/MIC ratio was > 125 for serum and > 100 for sputum, and when Cmax/MIC was > 10.01 for serum and > 8.01 for sputum following the first dose. The pharmacodynamics values that we have obtained in sputum with levofloxacin may be used as predictors of therapy outcomes.