Levofloxacin
General
- Type: 3rd generation Fluoroquinolones
- Dosage Forms: PO, IV, Inhaled
- Common Trade Names: Levaquin
Adult Dosing
Indications by Disease
| Disease | Dose | Context |
|---|---|---|
| Acute cystitis | 500mg QD x 14d | Urethritis Concern |
| Acute diarrhea | 500mg PO once daily x 5 days | Salmonella |
| Acute diarrhea | 500mg PO once daily x 5 days | Shigella |
| Acute diarrhea | 500mg PO once daily | Yersinia |
| Bacterial conjunctivitis | 0.5% ophthalmic solution 1-2 drops every 2 hours for 2 days THEN every 6 hours for 5 days | Bacterial Conjunctivitis, Topical |
| Corneal abrasion | 0.5% solution 2 drops ever 2 hours for 2 days THEN q6hrs for 5 days | Contact Lens |
| Epididymitis | 500 mg orally once a day for 10 days | STI + Enteric (MSM) |
| Erysipelas | 500mg PO/IV daily x 10 days | Alternative |
| Infectious tenosynovitis | 750 mg IV once daily | Empiric |
| Peritonitis | 750mg IV once daily | Primary |
| Peritonitis | 750mg IV once daily | Allergy/Prior exposure |
| Pneumonia (main) | 750mg IV/PO once daily | Inpatient, CAP Non-ICU |
| Pneumonia (main) | 750mg IV q24h | VAP, High Risk |
| Pneumonia (main) | 750mg IV q24h | HAP, High Risk |
| Pneumonia (main) | 750mg IV daily | ICU, Risk of Pseudomonas |
| Pneumonia (main) | 750mg IV | ICU, Low Risk |
| Pneumonia (main) | 750 mg daily | Outpatient, Unhealthy |
| Prostatitis | 500mg PO daily x 28 days | Non-STD/Chronic |
| Pyelonephritis | 750mg PO QD x7 days | Outpatient |
| Skin and soft tissue infections | Uncomplicated; 500mg PO/IV q24h x 7-10 days; Complicated; 750mg PO/IV q24h x 7-14 days | Skin infection |
Pediatric Dosing
Indications by Disease
Special Populations
- Pregnancy Rating: C
- Lactation: Probably Safe
- Renal Dosing
- Adult
- If usual dose is 750mg qd
- CrCl 20-49: 750mg q48h
- CrCl 10-19: 750mg x1 then 500mg q48h
- CrCl <10: Not defined
- HD/PD: No supplement
- If usual dose is 500mg qd
- CrCl 20-49: 500mg x1, then 250mg q24h
- CrCl 10-19: 500mg x1, then 250mg q48h
- CrCl <10: Not defined
- HD/PD: No supplement
- If usual dose is 250mg qd
- CrCl 10-19: 250mg q48h
- CrCl <10: Not defined
- HD/PD: No supplement
- If usual dose is 750mg qd
- Pediatric
- CrCl 10-29: Give q24h
- CrCl <10: Give q48h
- HD/PD: No supplement
- Adult
- Hepatic Dosing: not defined
Contraindications
- Allergy to class/drug
- Myasthenia gravis
- Long QT
- Uncorrected electrolyte abnormalities
Adverse Reactions
Serious
- Anaphylaxis, hypersensitivity
- Phototoxicity
- C. difficile diarrhea
- Seizures
- Depression / suicidal ideation
- Torsades de Pointes
- Vasculitis
- Renal toxicity
- Hepatic toxicity
- Tendon rupture/tendinitis (black box warning, inc aged 60+/immunosuppressed/corticosteroid use)
- Myasthenia exacerbation
- Severe Hypoglycemia [1]
Common
Pharmacology
- Half-life: 6-8 h
- Metabolism: CYP450
- Excretion: Urine
- Mechanism of Action: Bactericidal, inhibits DNA gyrase / Topoisomerase IV
Antibiotic Sensitivities[2]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
See Also
References
- ↑ FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions. US Food and Drug Administration. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm612995.htm. Updated July 10, 2018. Accessed Oct 22, 2018.
- ↑ Sanford Guide to Antimicrobial Therapy 2014