Subject(s)
Humans , Male , Female , Helicobacter pylori/drug effects , Helicobacter Infections/drug therapy , Levofloxacin/administration & dosage , Drug Administration Schedule , Reproducibility of Results , Treatment Outcome , Evidence-Based Medicine , Drug Therapy, Combination , Intention to Treat Analysis , Esomeprazole/administration & dosage , Amoxicillin/administration & dosage , Metronidazole/administration & dosageSubject(s)
Humans , Male , Female , Adult , Young Adult , Rifampin/administration & dosage , Tuberculosis, Meningeal/drug therapy , AIDS-Related Opportunistic Infections/drug therapy , Levofloxacin/administration & dosage , Antitubercular Agents/administration & dosage , Rifampin/adverse effects , Tuberculosis, Meningeal/complications , Tuberculosis, Meningeal/mortality , HIV Infections/complications , Proportional Hazards Models , Double-Blind Method , Drug Resistance, Bacterial , Drug Therapy, Combination , Kaplan-Meier Estimate , Levofloxacin/adverse effects , Mycobacterium tuberculosis/drug effects , Antitubercular Agents/adverse effectsABSTRACT
Abstract Aim The aim of this study was to compare both the efficacy and safety profile of the WHO-recommended, dual therapy (doxycycline–rifampin) to a quinolone-based, triple therapy (doxycycline–rifampin–levofloxacin) for treating acute/subacute brucellosis. Patients and methods We studied 107 consecutive, naïve patients with acute/subacute brucellosis admitted to Assiut University Hospital. Patients were randomly allocated to receive the dual therapy of doxycycline–rifampin (group-A) or to receive the triple therapy of doxycycline–rifampin–levofloxacin (group-B). Acute/subacute brucellosis was diagnosed based on the presence of: (1) contact with animals or fresh animal products, (2) suggestive clinical manifestations of less than one-year duration, and (3) positive antibody titer (1:160) by standard tube agglutination test. Results There was no significant difference between the two groups regarding their demographic data. Fever was the most frequent manifestation (96.3%). Epigastric pain was the most frequent adverse effect of treatment (12.1%). Group-A patients had a significantly higher relapse rate compared to group-B patients (22.6% versus 9.3%, p-value = 0.01). The rate of treatment adverse effects was higher among group-B patients, although not reaching statistical significance (20.4% versus 11.3%, p-value = 0.059). Conclusions Adding levofloxacin to the dual therapy for acute/subacute brucellosis (doxycycline–rifampin) may increase its efficacy in terms of lowering the relapse rate of the disease. Further, larger scale studies are needed before considering modifying the standard, dual therapy for brucellosis.
Subject(s)
Humans , Male , Female , Adult , Rifampin/administration & dosage , Brucellosis/drug therapy , Doxycycline/administration & dosage , Levofloxacin/administration & dosage , Anti-Bacterial Agents/administration & dosage , Acute Disease , Treatment Outcome , Drug Therapy, CombinationABSTRACT
Fluoroquinolones are broad-spectrum antibiotics, work against Gram-positive and Gram-negative bacteria and are a clinically proven option for many resistant infections. Among fluoroquinolones Levofloxacin works best against acute sinusitis, inflammation of the lower airways, acute exacerbation of chronic bronchitis, community acquired pneumonia, complicated urinary tract infection including Pyelonephritis, chronic bacterial prostatitis and skin and soft tissue infection. Levofloxacin is a frequently prescribed antibacterial agent with Diclofenac Sodium for pain management in infectious conditions. The objective of the present work is to evaluate the level of interaction between Levofloxacin and Diclofenac Sodium. In this work market available brands of both drugs were also evaluated for quality. The physiochemical parameters like weight variation, thickness variation, and mechanical strength were determined. Similarly the percentage drug release and content uniformity test were also analyzed; the tested quality attributes were found within the recommended pharmacopeia ranges except brand L6 that had high drug content 124.629 +/- 3.614 while brand L[4] and L[5] were not found similar in pH 1.2. When subjected to model dependent analysis Levofloxacin showed compliance with [first order, Higuchi, Hixson Crowell and Weibull] at pH [1.2, 4.5 and 6.8]. However Diclofenac Sodium showed adherence with [first order, Hixson Crowell and Weibull] at pH [1.2, 4.5 and 6.8] but following Higuchi at pH 1.2 and 4.5 only. The interaction studies were also performed spectrophotometrically and simultaneous equation was used to estimate the percentage availability of both the drugs at pH 4.5, 6.8, FaSSGF and FaSSIF. The studies showed that the percent availability of Levofloxacin was increased significantly in FaSSIF i.e. 129.173 +/- 0.323 at 45 minutes in the presence of Diclofenac Sodium
Subject(s)
Levofloxacin , Diclofenac , Drug Interactions , In Vitro Techniques , Levofloxacin/administration & dosage , Diclofenac/administration & dosage , FluoroquinolonesABSTRACT
La Neumonía Asociada a la Comunidad (NAC), es una enfermedad resultante de la inflamación del parénquima pulmonar generada por un agente infeccioso fuera del ambiente hospitalario. El cuadro clínico se caracteriza por tos, fiebre y signos de consolidación al examen físico, pero puede ser muy variable y mostrar tros síntomas locales como disnea, dolor torácico, expectoración, taquipnea, o generales como fiebre, scalofríos confusión y taquicardia. Descripción de las tecnologías. Moxifloxacina y levofloxacina son fluoroquinolonas. Las fluoroquinolonas son agentes bactericidas que actúan inhibiendo la ADN-girasa, enzima que interviene en el plegamiento de la doble hélice de ADN y es fundamental para la estructura tridimensional del material genético, ejerciendo su acción a nivel intracelular. Su actividad depende fundamentalmente de dos factores, como son la capacidad de atravesar la barrera citoplásmica y la afinidad por las ADN-girasas de las bacterias. Evaluación de efectividad y seguridad: ¿Cuál es la efectividad y seguridad de levofloxacina y moxifloxacina como monoterapia, comparadas con la combinación amoxicilina/ácido clavulánico y doxiciclina, para el tratamiento ambulatorio de la NAC en adultos con comorbilidades, o con alergia o intolerancia a los betalactámicos? La pregunta de evaluación fue refinada y validada con base en: autorización de mercadeo de las tecnologías para la indicación de interés (registro sanitario INVIMA), listado de medicamentos vitales no disponibles, cobertura de las tecnologías en el Plan Obligatorio de Salud (POS) (Acuerdo 029 de 2011), revisión de grupos terapéuticos clasificación ATC: Anatomical, Therapeutic, Chemical classification system), recomendaciones de guías de práctica clínica actualizadas, disponibilidad de evidencia sobre efectividad y seguridad (reportes de evaluación de tecnologías y revisiones sistemáticas de la literatura), uso de las tecnologías (listas nacionales de recobro, esta dísticas de prescripción, etc) y estudios de carga de enfermedad. Población: Adultos con neumonía asociada a la c\r\nomunidad y comorbilidades, o con alergia o intolerancia a los betalactámicos. Tecnologías de interés: L\r\nevofloxacina y moxifloxacina. Metodología: Búsqueda de literatura, Búsqueda en bases de datos electrónicas. Conclusiones: Moxifloxacina en comparación con amoxicilina/ácido clavulánico es igualmente efectiva en cuanto a tasas de curación, eventos adversos y mortalidad, en pacientes con NAC. No se encontró evidencia de comparación de levofloxacina o moxifloxacina con la doxiciclina.