In vitro activity of levonadifloxacin, the active drug of orally administered prodrug alalevonadifloxacin against bloodstream isolates of Burkholderia pseudomallei

Background and objective: Eradication of Burkholderia pseudomallei infections requires prolonged antibiotic treatment indicating microbiological and pharmacokinetic limitations of current options. Methods and results: Levonadifloxacin, a novel benzoquinolizine-fluoroquinolone available intravenously and orally, showed greater activity than ciprofloxacin (MICs, 0.25 to 2 versus 0.25-8 mg/L) and comparable to doxycycline against 50 B. pseudomallei isolates. In time-kill assay, levonadifloxacin exerted rapid -3 log10 reduction while doxycycline was bacteriostatic. Conclusion: Levonadifloxacin merits further investigations as a potential treatment option for B. pseudomallei infections.