Treatment of pyogenic (non-tuberculous) spondylodiscitis with tailored high-dose levofloxacin plus rifampicin

Pierluigi Viale, Mario Furlanut, Luigia Scudeller, Federica Pavan, Camilla Negri, Massimo Crapis, Eleonora Zamparini, Chiara Zuiani, Francesco Cristini, Federico Pea

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

The purpose of this study was to assess the clinical efficacy of high-dose levofloxacin plus rifampicin in the empirical treatment of non-tuberculous spondylodiscitis in an epidemiological context of low incidence of staphylococcal fluoroquinolone resistance. All consecutive adult patients with spondylodiscitis (January 2003 to December 2006) were empirically treated with high-dose levofloxacin (500 mg every 12 h normalised to renal function and optimised by means of therapeutic drug monitoring whenever feasible) plus rifampicin 600 mg every 24 h. Trough and peak plasma concentrations were targeted at 1-3 mg/L and 6-9 mg/L, respectively, to maximise the concentration-dependent activity of levofloxacin in bone. Follow-up was performed until 9 months after the end of therapy. Forty-eight patients were included. Eleven patients underwent a surgical approach for spine stabilisation. Among the 29 bacterial isolates, Staphylococcus aureus was the most frequent (65.5%) (all meticillin-susceptible strains). Tailored levofloxacin plasma exposure over time was ensured in most cases. Median treatment duration was 15.1 weeks. Overall response rates were: 77.1% at the intent-to-treat analysis; 84.1% among patients who completed therapy (N = 44); and 96.3% among those receiving targeted therapy against documented levofloxacin-susceptible isolates (N = 27). No patient had evidence of disease relapse at follow-up. Our findings suggest that high-dose levofloxacin regimens may be highly effective in the treatment of non-tuberculous spondylodiscitis and support its putative role in combination with rifampicin against S. aureus.

Original languageEnglish
Pages (from-to)379-382
Number of pages4
JournalInternational Journal of Antimicrobial Agents
Volume33
Issue number4
DOIs
Publication statusPublished - Apr 2009

Fingerprint

Discitis
Levofloxacin
Rifampin
Staphylococcus aureus
Therapeutics
Methicillin
Drug Monitoring
Fluoroquinolones
Spine
Kidney
Bone and Bones
Recurrence
Incidence

Keywords

  • Clinical efficacy
  • Levofloxacin
  • Pharmacokinetics/pharmacodynamics
  • Spondylodiscitis
  • Tailored therapy

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Treatment of pyogenic (non-tuberculous) spondylodiscitis with tailored high-dose levofloxacin plus rifampicin. / Viale, Pierluigi; Furlanut, Mario; Scudeller, Luigia; Pavan, Federica; Negri, Camilla; Crapis, Massimo; Zamparini, Eleonora; Zuiani, Chiara; Cristini, Francesco; Pea, Federico.

In: International Journal of Antimicrobial Agents, Vol. 33, No. 4, 04.2009, p. 379-382.

Research output: Contribution to journalArticle

Viale, Pierluigi ; Furlanut, Mario ; Scudeller, Luigia ; Pavan, Federica ; Negri, Camilla ; Crapis, Massimo ; Zamparini, Eleonora ; Zuiani, Chiara ; Cristini, Francesco ; Pea, Federico. / Treatment of pyogenic (non-tuberculous) spondylodiscitis with tailored high-dose levofloxacin plus rifampicin. In: International Journal of Antimicrobial Agents. 2009 ; Vol. 33, No. 4. pp. 379-382.
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AU - Negri, Camilla

AU - Crapis, Massimo

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