Levofloxacin (Page 13 of 16)

14.7 Complicated Urinary Tract Infections and Acute Pyelonephritis: 5-day Treatment Regimen

To evaluate the safety and efficacy of the higher dose and shorter course of levofloxacin, 1109 patients with cUTI and AP were enrolled in a randomized, double-blind, multicenter clinical trial conducted in the US from November 2004 to April 2006 comparing levofloxacin 750 mg IV or orally once daily for 5 days (546 patients) with ciprofloxacin 400 mg IV or 500 mg orally twice daily for 10 days (563 patients). Patients with AP complicated by underlying renal diseases or conditions such as complete obstruction, surgery, transplantation, concurrent infection or congenital malformation were excluded. Efficacy was measured by bacteriologic eradication of the baseline organism(s) at the post-therapy visit in patients with a pathogen identified at baseline. The post-therapy (test-of-cure) visit occurred 10 to 14 days after the last active dose of levofloxacin and 5 to 9 days after the last dose of active ciprofloxacin.

The bacteriologic cure rates overall for levofloxacin and control at the test-of-cure (TOC) visit for the group of all patients with a documented pathogen at baseline (modified intent to treat or mITT) and the group of patients in the mITT population who closely followed the protocol (Microbiologically Evaluable) are summarized in Table 16. Table 16: Bacteriological Eradication at Test-of-Cure

Levofloxacin 750 mg orally or IV once daily for 5 days Ciprofloxacin 400 mg IV/500 mg orally twice daily for 10 days Overall Difference [95% CI]
n/N % n/N % Levofloxacin Ciprofloxacin
*
The mITT population included patients who received study medication and who had a positive (=105 CFU/mL) urine culture with no more than 2 uropathogens at baseline. Patients with missing response were counted as failures in this analysis.
The Microbiologically Evaluable population included patients with a confirmed diagnosis of cUTI or AP, a causative organism(s) at baseline present at = 105 CFU/mL, a valid test-of-cure urine culture, no pathogen isolated from blood resistant to study drug, no premature discontinuation or loss to follow-up, and compliance with treatment (among other criteria).
mITT Population *
Overall (cUTI or AP) 252/333 75.7 239/318 75.2 0.5 (-6.1, 7.1)
cUTI 168/230 73.0 157/213 73.7
AP 84/103 81.6 82/105 78.1
Microbiologically Evaluable Population
Overall (cUTI or AP) 228/265 86.0 215/241 89.2 -3.2 [-8.9, 2.5]
cUTI 154/185 83.2 144/165 87.3
AP 74/80 92.5 71/76 93.4

Microbiologic eradication rates in the Microbiologically Evaluable population at TOC for individual pathogens recovered from patients randomized to levofloxacin treatment are presented in Table 17.

Table 17: Bacteriological Eradication Rates for Individual Pathogens Recovered From Patients Randomized to levofloxacin 750 mg QD for 5 Days Treatment
Pathogen Bacteriological Eradication Rate (n/N) %
*
The predominant organism isolated from patients with AP was E. coli: 91% (63/69) eradication in AP and 89% (92/103) in patients with cUTI
Escherichia coli * 155/172 90
Klebsiella pneumoniae 20/23 87
Proteus mirabilis 12/12 100

14.8 Complicated Urinary Tract Infections and Acute Pyelonephritis: 10-day Treatment Regimen

To evaluate the safety and efficacy of the 250 mg dose, 10 day regimen oflevofloxacin, 567 patients with uncomplicated UTI, mild-to-moderate cUTI, and mild-to-moderate AP were enrolled in a randomized, double-blind, multicenter clinical trial conducted in the US from June 1993 to January 1995 comparing levofloxacin 250 orally once daily for 10 days (285 patients) with ciprofloxacin 500 mg orally twice daily for 10 days (282 patients). Patients with a resistant pathogen, recurrent UTI, women over age 55 years, and with an indwelling catheter were initially excluded, prior to protocol amendment which took place after 30% of enrollment. Microbiological efficacy was measured by bacteriologic eradication of the baseline organism(s) at 1–12 days post-therapy in patients with a pathogen identified at baseline.

The bacteriologic cure rates overall for levofloxacin and control at the test-of-cure (TOC) visit for the group of all patients with a documented pathogen at baseline (modified intent to treat or mITT) and the group of patients in the mITT population who closely followed the protocol (Microbiologically Evaluable) are summarized in Table 18.

*
1–9 days posttherapy for 30% of subjects enrolled prior to a protocol amendment; 5–12 days posttherapy for 70% of subjects.
The mITT population included patients who had a pathogen isolated at baseline. Patients with missing response were counted as failures in this analysis.
The Microbiologically Evaluable population included mITT patients who met protocol-specified evaluability criteria.
Table 18: Bacteriologic Eradication Overall (cUTI or AP) at Test-Of-Cure *
Levofloxacin 250 mg once daily for 10 days Ciprofloxacin 500 mg twice daily for 10 days
n/N % n/N %
mITT Population 174/209 83.3 184/219 84.0
Microbiologically Evaluable Population 164/177 92.7 159/171 93.0

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