UMEM Educational Pearls - By Jill Logan

Category: Pharmacology & Therapeutics

Title: Levofloxacin dosing for CAP

Keywords: Levofloxacin, duration, dose, CAP, pneumonia (PubMed Search)

Posted: 7/1/2017 by Jill Logan (Updated: 9/27/2022)
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Takeaways

When you look up dosing for levofloxacin for community acquired pneumonia (CAP), you will find that both of the following options are approved:

  • Levofloxacin 500 mg IV/PO daily x 7-14 days
  • Levofloxacin 750 mg IV/PO daily x 5 days

This is based on a multicenter, randomized, double-blind, active treatment trial comparing these two regimens in CAP (mild to severe). This non-inferiority trial shows that the 750 mg dose of levofloxacin for 5 days is "at least as effective and well tolerated" as the 500 mg dose of levofloxacin for 10 days.

So why should you choose the 750 mg daily x 5 day regimen?

  • Higher doses maximize the concentration-dependent pharmacokinetic profile of the drug
  • Higher doses and shorter duration may be associated with less drug resistance
  • Patients subjectively report feeling better at day 3 with the higher dose regimen

As alway with levofloxacin, don't forget to renally dose adjust subsequent doses when writting a script or scheduled inpatient order for patients with reduced creatinine clearance! 

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Category: Pharmacology & Therapeutics

Title: S.aureus in the urine and the risk for bacteremia

Keywords: MSSA, MRSA, bacturia, bacteremia, Staph aureus, Staphlococcus aureus (PubMed Search)

Posted: 6/4/2017 by Jill Logan (Updated: 9/27/2022)
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Takeaways

  • The incidence of Staphylococcus aurea as a urinary pathogen is increasing, however, this finding may represent more than a simple urinary tract infection.
  • One review found an 8-21%rate of association between S. aureus in the urine with bacteremia.
  • Additional work up, including blood cultures, may be warranted in patients with systemic symptoms, lack of access to follow up, and no urinary tract pathology or instrumentation.

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