Catheter-associated urinary tract infection IDSA guidelines: why the levofloxacin?
Abstract
To the Editor—Earlier this year, the Infectious Diseases Society of America (IDSA) published their 2009 International Clinical Practice Guidelines on the diagnosis, prevention, and treatment of catheter-associated urinary tract infection (CAUTI) in adults [1]. We commend the article's panel of experts for their comprehensive and clinical in-depth review of catheter-associated asymptomatic bacteriuria and symptomatic urinary tract infection. However, we disagree with their specific recommendation that a 5-day regimen of levofloxacin be considered in patients with CA-UTI who are not severely ill. We strongly believe that this recommendation is based on weak supporting data, may have a greater propensity for adverse events, and does not constitute the best use of this fluoroquinolone agent. The sole specific antimicrobial agent treatment recommendation in the entire document is for using levofloxacin (5 days, no dose cited). Interestingly, the strength assigned to this recommendation is only moderate, and the quality of evidence lacks well-designed clinical trial scrutiny (B-III). It appears that their choice of levofloxacin is based on a single trial which found that levofloxacin (750 mg once daily for 5 days) was both microbiologically and clinically noninferior to ciprofloxacin (400/500 mg twice-daily for 10 days) for the treatment of complicated urinary tract infections and acute pyelonephritis [2]. In a small subset of patients who had a urinary catheter in place, a…
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