Activity of levofloxacin and ciprofloxacin against urinary pathogens

This study compares the antibacterial activities of levofloxacin and ciprofloxacin against recently isolated urinary tract pathogens, by evaluating their MICs and MBCs in accordance with NCCLS susceptibility tests, time–kill curves and interference with bacterial adhesion to uroepithelial cells. A total of 200 clinical isolates was tested, including the species Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Proteus vulgaris, Providencia rettgeri, Pseudomonas aeruginosa, Enterococcus faecalis, Staphylococcus aureus and Staphylococcus epidermidis. All E. coli isolates were susceptible to levofloxacin and only one was resistant to ciprofloxacin, and there were no differences between β-lactamase-positive and -negative strains. K. pneumoniae strains resistant to ciprofloxacin were also resistant to levofloxacin. Methicillin-resistant S. aureus seemed to be less susceptible than methicillin-susceptible strains to these quinolones. S. epidermidis strains were susceptible to levofloxacin and ciprofloxacin, with the exception of two isolates. Incubation of S. aureus and E. coli with subinhibitory antimicrobial concentrations reduced their capacity to adhere to uroepithelial cells; this was statistically significant at 0.25 × MIC with respect to controls (P < 0.05). Inhibition of adhesion ranged from 36 to 43% when bacteria were incubated in the presence of 0.25 × MIC of levofloxacin and ciprofloxacin, and from 10 to 27% at 0.125 × MIC. These findings suggest that levofloxacin is an effective alternative to ciprofloxacin in the treatment of urinary tract infections and that sub-inhibitory concentrations may contribute to efficacy.