Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies

Department Chair

John Cavenagh, PhD, PA-C


OBJECTIVE: The objective of this systematic review is to determine whether or not levofloxacin is a more effective treatment than ciprofloxacin in adult patients with Acute Pyelonephritis (AP).

STUDY DESIGN: Review of three English language primary double-blind randomized controlled trial studies comparing levofloxacin to ciprofloxacin for the treatment of AP in adults.

DATA SOURCES: Randomized controlled double-blind comparative trials were found using Cochrane, PubMed, and Science Direct databases.

OUTCOME MEASURED: All studies measured three outcomes: microbiologic eradication, clinical response, and safety and tolerability of the medication. Microbiologic eradication was measured by urine culture which demonstrated a reduction of pathogens to/mL. Clinical response was measured by: cured (complete resolution of signs and symptoms associated with active infection); improved (incomplete resolution of signs and symptoms but no additional antimicrobial therapy required); failed (no response to therapy); or unable to evaluate (patient did not return for follow-up evaluation). Safety and tolerability information was collected through post therapy follow up visits.

RESULTS: The dichotomous data systematically reviewed in all three RCTs determined that there is a minimal relative and absolute benefit increase in the use of levofloxacin over ciprofloxacin in the treatment of AP in adults. Confidence Intervals calculated in all studies prove that this data is statistically significant. Adverse events and/or serious adverse events were noted in all three trials with the use of both levofloxacin and ciprofloxacin, however, very few were considered to be treatment related.

CONCLUSIONS: The results of these three studies show that the use of levofloxacin for the treatment of AP in adult patients is as effective as ciprofloxacin in regard to microbiologic eradication, efficacy, and safety and tolerability.