Viale Pierluigi, Furlanut Mario, Scudeller Luigia, Pavan Federica, Negri Camilla, Crapis Massimo, Zamparini Eleonora, Zuiani Chiara, Cristini Francesco, Pea Federico
Clinic of Infectious Diseases, Department of Medical and Morphological Research, Medical School, University of Udine, Italy.
Int J Antimicrob Agents. 2009 Apr;33(4):379-82. doi: 10.1016/j.ijantimicag.2008.09.011. Epub 2008 Dec 18.
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.
本研究的目的是在葡萄球菌对氟喹诺酮耐药率较低的流行病学背景下，评估大剂量左氧氟沙星联合利福平经验性治疗非结核性脊椎椎间盘炎的临床疗效。对所有连续性成年脊椎椎间盘炎患者（2003年1月至2006年12月）采用大剂量左氧氟沙星（根据肾功能调整为每12小时500mg，可行时通过治疗药物监测进行优化）联合利福平每24小时600mg进行经验性治疗。左氧氟沙星的谷浓度和峰浓度分别目标设定为1 - 3mg/L和6 - 9mg/L，以最大化左氧氟沙星在骨组织中的浓度依赖性活性。随访至治疗结束后9个月。共纳入48例患者。11例患者接受了脊柱稳定手术。在29株细菌分离株中，金黄色葡萄球菌最为常见（65.5%）（均为对甲氧西林敏感菌株）。多数情况下确保了左氧氟沙星血浆暴露量随时间的精准调整。中位治疗持续时间为15.1周。总体有效率为：意向性分析时为77.1%；完成治疗的患者中为84.1%（N = 44）；针对已记录的对左氧氟沙星敏感分离株进行靶向治疗的患者中为96.3%（N = 27）。随访期间无患者出现疾病复发迹象。我们的研究结果表明，大剂量左氧氟沙星方案在治疗非结核性脊椎椎间盘炎方面可能非常有效，并支持其与利福平联合用于对抗金黄色葡萄球菌的假定作用。
