Levofloxacin

General

• Type: Fluoroquinolone
• Dosage Forms:
  • PO
  • IV
  • Inhalational
• Common Trade Names: Levaquin

Adult Dosing

Pneumonia

• Community acquired
  • 750mg PO/IV q24h x 5 days
• Nosocomial
  • 750 gm PO/IV q24h x 7-14 days

Prostatitis

• 500 MG PO/IV q24h x 28 days

Pyelonephritis

• 750mg PO/IV q24h x 5 days

Skin infection

• Uncomplicated
  • 500mg PO/IV q24h x 7-10 days
• Complicated
  • 750mg PO/IV q24h x 7-14 days

UTI

• Uncomplicated
  • 250mg PO/IV q24h x 3days
• Complicated
  • 750mg PO/IV q24h x 5 days

Pediatric Dosing

Pneumonia (Community acquired)

• 6 months - 4 years old
  • 16-20mg/kg/day IV or PO, divided q12h x 10 days
• 5-16 years old
  • 8-10mg/kg/day IV or PO, divided q12h x 10 days

Special Populations

• Pregnancy Rating: C
• Lactation: Probably Safe
• Renal Dosing
  • Adult
  • Pediatric
• Hepatic Dosing
  • Adult
  • Pediatric

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

Common

• Nausea / Vomiting
• Headache
• Diarrhea
• Insomnia
• Constipation
• Dizziness
• Abdominal pain
• Tendinitis

Pharmacology

• Half-life: 6-8 h
• Metabolism: CYP450
• Excretion: Urine
• Mechanism of Action: Bactericidal, inhibits DNA gyrase / Topoisomerase IV

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	S
	Strep. anginosus gp	S
	Enterococcus faecalis	S
	Enterococcus faecium	R
	MSSA	S
	MRSA	R
	CA-MRSA	I
	Staph. Epidermidis	S
	C. jeikeium	X1
	L. monocytogenes	S
Gram Negatives	N. gonorrhoeae	I
	N. meningitidis	S
	Moraxella catarrhalis	S
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	S
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	S
	Enterobacter sp, AmpC pos	S
	Serratia sp	S
	Serratia marcescens	X1
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	S
	Providencia sp.	S
	Morganella sp.	S
	Citrobacter freundii	S
	Citrobacter diversus	S
	Citrobacter sp.	S
	Aeromonas sp	S
	Acinetobacter sp.	I
	Pseudomonas aeruginosa	I
	Burkholderia cepacia	X1
	Stenotrophomonas maltophilia	I
	Yersinia enterocolitica	S
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	S
	Pasteurella multocida	S
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	S
	Mycoplasm pneumoniae	S
	Rickettsia sp	X1
	Mycobacterium avium	X1
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	R
	Prevotella melaninogenica	S
	Clostridium difficile	R
	Clostridium (not difficile)	S
	Fusobacterium necrophorum	X1
	Peptostreptococcus sp.	S

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

• Antibiotics (Main)

References

Authors

Ross Donaldson