Treatment duration ranged from 5 to 28 days and definition for posttherapy was shown in Supplementary Table S1. As the population for analysis were various intent-to-treat, modified intent-to-treat and microbially evaluable, respective definition could be seen in Supplementary Table S1 , the pattern adopted by all corresponding articles was chosen to pool the outcome measurement except for adverse event, whose data came from all patients received 1 or more dose of studied drugs.
Two studies Richard et al. A higher incidence could be found in end-of-therapy RR: 1. For the absence of posttherapy microbial eradication rate, relevant analysis was unable to conduct.
No evidence proved a significant difference with respect to microbial eradication rate at end-of-therapy RR: 1. And no serious adverse event was reported. Comparison between levofloxacin and ciprofloxacin in acute pyelonephritis; 2 A end-of-therapy clinical success rate; 2 B posttherapy clinical success rate; 2 C microbial eradication rate; 2 D adverse event rate.
The rate of clinical improvement, microbiological eradication and adverse event were reported by 3 articles Bundrick et al. As for the clinical effective rate, no matter at end-of-therapy RR: 1. Comparison between levofloxacin and ciprofloxacin in chronic bacterial prostatitis; 3 A end-of-therapy clinical success rate; 3 B posttherapy clinical success rate; 3 C end-of-therapy microbial eradication rate; 3 D posttherapy microbial eradication rate; 3 E adverse event rate.
When compared directly, the levofloxacin and ciprofloxacin did not show a significant divergence in adverse event rate RR: 1. No treatment-related death case was mentioned by all 3 studies. UTIs are becoming a global health issue and induce significant quantity of societal cost Flores-Mireles et al. Timely and effective antibiotic treatment, together with nutraceutical, could reduce the long-term damage to reproductive system Mongioi et al.
In the treatment of UTIs, although the guidelines list levofloxacin and ciprofloxacin as first-line drugs for cUTIs and AP, no evidence-based research has proven the comparative advantage of the either one.
Currently, there is no meta-analysis on this issue. Under these conditions, we performed a latest systematic review and pooled analysis of all available trials. For AP and CBP treatment, the analysis did not show significant statistical difference in terms of end-of-therapy or posttherapy clinical effective rate and microbial eradication rate. The adverse event rate shared a similar finding.
The isolated bacteria from urine sample could account for this controversy. The most common uropathogen was E. Nowadays, the prevalence of resistant E. Based on the fact that the minimal inhibitory concentration of levofloxacin for resistant E. But it did not mean that levofloxacin was recommended for E. Limited by existing studies, the hypothesis could be hardly confirmed unless RCTs with a large sample performed.
But it was consistent with pharmacologic research. Drusano et al. Wagenlehner et al. It proved reasonable explanation for the non-inferiority of levofloxacin, whose minimum inhibitory concentration for uropathogen was higher in disk diffusion, compared with ciprofloxacin. For the adverse event, the 2 drugs were comparable and no noteworthy serious or death case came into publication. The most common side effect were digest tract symptom flatulence and diarrhea and central nervous symptom headache, dizziness and nausea , which was consistent with existing report Stahlmann and Lode, No adverse event was considered directly related to treatment except for an allergic reaction case Peterson et al.
Known severe side effect, such as QT prolongation, seizure and tendon rupture Stahlmann and Lode, , were not reported by all 5 trials. All mentioned above proved that levofloxacin and ciprofloxacin were both with safety in clinical application.
There were several limitations in our meta-analysis. First, the quantity of available studies were small, resulting in inadequate statistical confidence. RCTs with larger scale were necessary to furtherly explore the answer. Second, the difference in standard course and dose of the 2 drugs could bias the result. Some researchers held the view that as part of the short-course therapy, the course of levofloxacin treatment concluded 5 days sooner than that of ciprofloxacin 5 vs.
Third, it was the study design and the inclusion criteria of the individual RCTs that may be responsible for failing to reveal the differences between levofloxacin and ciprofloxacin.
Actually, most of these RCTs included were to show noninferiority between agents for drug registration and approval purposes. Therefore, they may fail to show clinical superiority of any antibiotic over another.
We have good reasons, though, to believe that the high quality of included RCTs could make up for this shortcoming. At present, this is the first evidence-based research comparing efficacy and safety between levofloxacin and ciprofloxacin as for urinary tract infection. There is no significant difference between the 2 drugs in end-of-therapy or posttherapy clinical success rate, microbial eradication rate or adverse event rate.
DC and YS have joint first authorship for this publication. DC and LY were responsible for conceptualizing and revising the manuscript. ZC and LL were involved in conceptualizing, proofreading and diagram preparation. All authors gave their final approval for the submission of the manuscript. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Afriyie, D. Comparative in vitro activity of ciprofloxacin and levofloxacin against isolated uropathogens in Ghana: a pilot study. Pan Afr. Bader, M. An update on the management of urinary tract infections in the era of antimicrobial resistance. Becnel Boyd, L. Conclusions: Levofloxacin mg once daily for 28 days is as effective as ciprofloxacin mg twice daily for 28 days for the treatment of chronic bacterial prostatitis.
Isolation of a high proportion of gram-positive organisms, as well as gram-negative pathogens, underscores the necessity of choosing an antimicrobial agent with broad-spectrum activity.
Abstract Objectives: To compare the safety and efficacy of levofloxacin with that of ciprofloxacin for the treatment of chronic bacterial prostatitis.
Primary Outcome Measures : Combination of clinical success and microbiologic eradication known as therapeutic response at post-therapy visit.
Eligibility Criteria. Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Exclusion Criteria: Allergy or serious adverse reaction to levofloxacin, ciprofloxacin, or other fluoroquinolone urinary tract surgery or lithotripsy treatment for kidney stones within 7 days before study entry a second coexisting bacterial infection that requires systemic antibiotics need for a second antibiotic to treat the urinary tract infection obstruction of the urinary tract prostate infection.
Contacts and Locations. Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials. More Information. Curr Med Res Opin. Identification and pretherapy susceptibility of pathogens in patients with complicated urinary tract infection or acute pyelonephritis enrolled in a clinical study in the United States from November through April Clin Ther.
J Am Board Fam Med. National Library of Medicine U. National Institutes of Health U. Department of Health and Human Services.
Urinary Tract Infections Pyelonephritis. Drug: levofloxacin. Phase 3.
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