Levofloxacin Versus Ceftriaxone for the Treatment of Acute Pyelonephritis in Iranian Adults

Introduction: Acute pyelonephritis is among the most common bacterial infections. Options for initial treatment of pyelonephritis include an extended-spectrum cephalosporin or a fluoroquinolone. This study aimed to compare the clinical outcomes of patients receiving ceftriaxone to those who received levofloxacin for the treatment of acute pyelonephritis. Methods: In this randomized, open-label trial, hospitalized adults with acute pyelonephritis were treated with ceftriaxone (1g IV every 12 hours) or levofloxacin (750 mg IV daily) for at least 7 days. Clinical and microbiological characteristics were compared among patients treated with ceftriaxone and levofloxacin. Results: A total of 59 patients were randomized, 30 to the ceftriaxone group and 29 to the levofloxacin group. The clinical response was that 68.0% of patients in the ceftriaxone group and 56.0% of patients in the levofloxacin group were cured. The microbiological response, i.e. pathogen eradication rates was 68.7% in the ceftriaxone group and 21.4% in the levofloxacin group. (P value=0.00028) Escherichia coli was the most common pathogen (n = 31), followed by Klebsiella pneumoniae (n = 21). High resistance rates were detected for cotrimoxazole (55%), ciprofloxacin (48%), and ceftriaxone (34.4%) in isolated E.coli. Likewise, all K. pneumoniae isolates were resistant to ciprofloxacin. Conclusion: This study indicates that ceftriaxone was more effective than levofloxacin in the treatment of acute pyelonephritis, on the basis of microbiological response, but there were no statistically significant differences between the treatment groups in the rates of clinical cure. The resistance of uropathogens to the most used antibiotics was relatively high. Choosing the treatment regimen based on susceptibility testing results and shortening the duration of the therapy are now recommended to be the most important approaches to decrease the spread of antibiotic resistance worldwide.