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Journal of Antimicrobial Chemotherapy (1999) 43, 345-349
© 1999 The British Society for Antimicrobial Chemotherapy

The antibacterial efficacy of levofloxacin and ciprofloxacin against Pseudomonas aeruginosaassessed by combining antibiotic exposure and bacterial susceptibility

Alasdair P. MacGowan*, Mandy Wootton and H. Alan Holt

Bristol Centre for Antimicrobial Research and Evaluation, Southmead Health Services NHS Trust and University of Bristol, Department of Medical Microbiology, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK

Ciprofloxacin has a four-fold greater in-vitro activity than levofloxacin against Pseudomonas aeruginosa, but levofloxacin has a four-fold higher area under the serum concentration-time curve (AUC) for an equivalent dose. It has been proposed that the AUC/MIC ratio is a general predictor of antibacterial efficacy for quinolones. Using an in-vitro kill curve technique, performed in quadruplicate, with nine antibiotic concentrations and three strains of P. aeruginosa with varying quinolone susceptibility, we constructed sigmoidal dose- response curves for AUC0–6.5/MIC and area under the bacterial kill curve (AUBKC) or AUC0–24/MIC and log change in viable count at 24 h ({Delta}24). For levofloxacin the log AUC0–6.5/MIC ratio to produce 50% of the maximal effect was 0.74 ± 0.13 (r2 = 0.9435) for levofloxacin and 0.82 ± 0.06 (r2 = 0.7935) for ciprofloxacin. The log AUC0–24/MIC ratio to produce 50% maximal effect was 1.58 ± 0.13 (r2 = 0.7788) for levofloxacin and 1.37 ± 0.12 (r2 = 0.7207) for ciprofloxacin. An AUC0–24/MIC ratio of 125 produced 85.4% of the maximal response with levofloxacin and 81.5% with ciprofloxacin. These data suggest that levofloxacin and ciprofloxacin have equivalent activity against P. aeruginosa at equivalent AUC/MIC ratios.

* Corresponding author. Tel: +44-117-9595652; Fax: +44-117-9593154.


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