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Pharmacokinetics

Pharmacokinetics and effects on bowel and throat microflora of oral levofloxacin as antibacterial prophylaxis in neutropenic patients with haematological malignancies

Bone Marrow Transplantation volume 33, pages 847–853 (2004)Cite this article

Summary:

Gram-positive breakthrough infections pose a major drawback to the use of quinolones for antibacterial prophylaxis in neutropenic patients. Levofloxacin offers the advantage of an augmented Gram-positive spectrum and may potentially overcome this problem. In an open-label, clinical pilot study, we investigated the effects on throat and bowel microflora and pharmacokinetics of a once-daily oral dose of 500 mg levofloxacin, during neutropenia in 20 patients with haematological malignancies. Gram-negative bowel flora and Staphylococcus aureus were successfully eradicated. No Gram-negative infections occurred. Minimal inhibitory concentration values for viridans group (VG) streptococci tended to increase, in four patients over 8 mg/l, indicating resistance to levofloxacin. Four patients developed blood-stream infections with levofloxacin-resistant Gram-positive cocci. No significant changes in numbers of anaerobic microorganisms were observed. Pharmacokinetic parameters of levofloxacin, including the maximum serum concentration (Cmax), time to Cmax (Tmax), area under the concentration–time curve (AUC), volume of distribution at steady state (Vss/F) and clearance (CL/F) were not statistically different at first dose and during neutropenia. In conclusion, levofloxacin eradicates Gram-negative microorganisms and S. aureus and spares the anaerobic flora. Its pharmacokinetic profile is unaltered during neutropenia. However, prolonged administration of levofloxacin as antibacterial prophylaxis may be hampered by the emergence of levofloxacin-resistant VG streptococci.

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Acknowledgements

This study was supported in part by a grant from Aventis Pharma BV, Hoevelaken, The Netherlands.

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Authors and Affiliations

  1. Department of Haematology, VU University Medical Centre, Amsterdam, The Netherlands

    G J Timmers & P C Huijgens

  2. Department of Pharmacy, VU University Medical Centre, Amsterdam, The Netherlands

    Y Dijstelbloem & D J Touw

  3. Department of Medical Microbiology and Infection Control, VU University Medical Centre, Amsterdam, The Netherlands

    A M Simoons-Smit & C M J E Vandenbroucke-Grauls

  4. Department of Oral Microbiology, Academic Centre for Dentistry, Amsterdam, The Netherlands

    A J van Winkelhoff

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  1. G J Timmers
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Correspondence to P C Huijgens.

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Timmers, G., Dijstelbloem, Y., Simoons-Smit, A. et al. Pharmacokinetics and effects on bowel and throat microflora of oral levofloxacin as antibacterial prophylaxis in neutropenic patients with haematological malignancies. Bone Marrow Transplant 33, 847–853 (2004). https://doi.org/10.1038/sj.bmt.1704431

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