title: Levofloxacin at the usual dosage to treat bone and joint infections: a cohort analysis.
abstract: Fluoroquinolones are recommended for the treatment of bone and joint infections (BJIs), and levofloxacin is commonly used in this setting. However, no pre-marketing clinical study has supported its use, especially its dosage, for treating BJIs. This study aimed to assess the benefit-risk ratio of levofloxacin administered orally at a standard dosage of 500 mg once daily (OD) in a cohort of patients with BJIs. The medical records of patients admitted to a large French teaching hospital for BJI over a 1-year period and managed by a multidisciplinary team were reviewed. Patient data were recorded on a standardised form and the outcome was assessed at the end of antibiotic treatment and after 1-year of follow-up. A total of 230 patients were included, of whom 79 were treated with an antibiotic regimen including levofloxacin (34%). Most BJIs (97%) were surgically treated by wound debridement and/or removal or replacement of the infected device. Adverse drug reactions to levofloxacin leading to treatment discontinuation occurred in three patients (4%). The antibiotic treatment duration was significantly longer in patients treated with levofloxacin compared with other antibiotic regimens (median, 13 weeks vs. 6 weeks). Post-treatment outcomes were considered favourable (total or partial recovery, including orthopaedics aftermath) in 89-93% of patients, with no significant difference between treatment groups. In conclusion, oral levofloxacin at 500 mg OD is a well-tolerated and efficacious antibiotic treatment for BJIs. Our approach of following-up all treated patients is a useful way to validate specific clinical practices.
authors.affiliation: EA3826-Thérapeutique expérimentale et clinique des infections, Faculté de Médecine de Nantes, 44035 Nantes, France; Service des maladies infectieuses, CHU de Nantes, Nantes, France. Electronic address: nathalie.asseray@chu-nantes.fr.
authors.forename: N
authors.initials: N
authors.lastname: Asseray
authors.affiliation: Service de bactériologie et hygiène, CHU de Nantes, Nantes, France.
authors.forename: C
authors.initials: C
authors.lastname: Bourigault
authors.affiliation: EA3826-Thérapeutique expérimentale et clinique des infections, Faculté de Médecine de Nantes, 44035 Nantes, France; Service des maladies infectieuses, CHU de Nantes, Nantes, France.
authors.forename: D
authors.initials: D
authors.lastname: Boutoille
authors.affiliation: Service de chirurgie orthopédique, CHU de Nantes, Nantes, France.
authors.forename: L
authors.initials: L
authors.lastname: Happi
authors.affiliation: Service de chirurgie orthopédique, CHU de Nantes, Nantes, France.
authors.forename: S
authors.initials: S
authors.lastname: Touchais
authors.affiliation: EA3826-Thérapeutique expérimentale et clinique des infections, Faculté de Médecine de Nantes, 44035 Nantes, France; Service de bactériologie et hygiène, CHU de Nantes, Nantes, France.
authors.forename: S
authors.initials: S
authors.lastname: Corvec
authors.affiliation: Service de bactériologie et hygiène, CHU de Nantes, Nantes, France.
authors.forename: P
authors.initials: P
authors.lastname: Bemer
authors.affiliation: EA3826-Thérapeutique expérimentale et clinique des infections, Faculté de Médecine de Nantes, 44035 Nantes, France; Pharmacie hospitalière, CHU de Nantes, Nantes, France.
authors.forename: D
authors.initials: D
authors.lastname: Navas
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003646:Debridement; D005260:Female; D005602:France; D006784:Hospitals, Teaching; D006801:Humans; D064704:Levofloxacin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000188:drug therapy* / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin
keywords: Bone and joint infections; Database; Levofloxacin; Risk–benefit ratio