Levofloxacin: Difference between revisions

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==General==
==General==
*Type:  
*Type: [[Is Generation:: 3rd generation]] [[Is DrugClass::Fluoroquinolones]]
*Dosage Forms:
*Dosage Forms: PO, IV, Inhaled
*Common Trade Names:  
*Common Trade Names: Levaquin


==Adult Dosing==
==Adult Dosing==
===Indications by Disease===
{{#ask: [[Has DrugName::Levofloxacin]] [[Has Population::Adult]]
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Context=Context
|format=table
|limit=50
|mainlabel=-
|headers=show
|sort=Treats disease
}}


==Pediatric Dosing==
==Pediatric Dosing==
===Indications by Disease===
{{#ask: [[Has DrugName::Levofloxacin]] [[Has Population::Pediatric]]
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Context=Context
|format=table
|limit=50
|mainlabel=-
|headers=show
|sort=Treats disease
}}


==Special Populations==
==Special Populations==
*Pregnancy:
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
*Lactation:
*Lactation: Probably Safe
*Renal Dosing
*Renal Dosing
**Adult
**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
**Pediatric
**Pediatric
*Hepatic Dosing
***CrCl 10-29: Give q24h
**Adult
***CrCl <10: Give q48h
**Pediatric
***HD/PD: No supplement
*Hepatic Dosing: not defined


==Contraindications==
==Contraindications==
*Allergy to class/drug
*Allergy to class/drug
*[[Myasthenia gravis]]
*[[Long QT]]
*Uncorrected [[electrolyte abnormalities]]


==Adverse Reactions==
==Adverse Reactions==
===Serious===
===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 <ref>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.</ref>


===Common===
===Common===
*[[Nausea/vomiting]], [[diarrhea]], [[constipation]], [[abdominal pain]]
*[[Headache]]
*[[Insomnia]]
*[[Dizziness]]
*[[Tendinitis]]


==Pharmacology==
==Pharmacology==
*Half-life:  
*Half-life: 6-8 h
*Metabolism:  
*Metabolism: CYP450
*Excretion:  
*Excretion: Urine
*Mechanism of Action:
*Mechanism of Action: Bactericidal, inhibits DNA gyrase / Topoisomerase IV
 
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Group'''
| align="center" style="background:#f0f0f0;"|'''Organism'''
| align="center" style="background:#f0f0f0;"|'''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===
{{Template:Antibacterial Spectra Key}}


==See Also==
==See Also==
*[[Antibiotics (Main)]]
*[[Antibiotics (Main)]]


==Source==
==References==
<references/>


<references/>
[[Category:Pharmacology]]
[[Category:Drugs]]
[[Category:ID]]

Latest revision as of 11:07, 20 March 2026

General

  • Type: 3rd generation Fluoroquinolones
  • Dosage Forms: PO, IV, Inhaled
  • Common Trade Names: Levaquin

Adult Dosing

Indications by Disease

DiseaseDoseContext
Acute cystitis500mg QD x 14dUrethritis Concern
Acute diarrhea500mg PO once daily x 5 daysSalmonella
Acute diarrhea500mg PO once daily x 5 daysShigella
Acute diarrhea500mg PO once dailyYersinia
Bacterial conjunctivitis0.5% ophthalmic solution 1-2 drops every 2 hours for 2 days THEN every 6 hours for 5 daysBacterial Conjunctivitis, Topical
Corneal abrasion0.5% solution 2 drops ever 2 hours for 2 days THEN q6hrs for 5 daysContact Lens
Epididymitis500 mg orally once a day for 10 daysSTI + Enteric (MSM)
Erysipelas500mg PO/IV daily x 10 daysAlternative
Infectious tenosynovitis750 mg IV once dailyEmpiric
Peritonitis750mg IV once dailyPrimary
Peritonitis750mg IV once dailyAllergy/Prior exposure
Pneumonia (main)750mg IV/PO once dailyInpatient, CAP Non-ICU
Pneumonia (main)750mg IV q24hVAP, High Risk
Pneumonia (main)750mg IV q24hHAP, High Risk
Pneumonia (main)750mg IV dailyICU, Risk of Pseudomonas
Pneumonia (main)750mg IVICU, Low Risk
Pneumonia (main)750 mg dailyOutpatient, Unhealthy
Prostatitis500mg PO daily x 28 daysNon-STD/Chronic
Pyelonephritis750mg PO QD x7 daysOutpatient
Skin and soft tissue infectionsUncomplicated; 500mg PO/IV q24h x 7-10 days; Complicated; 750mg PO/IV q24h x 7-14 daysSkin 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
    • Pediatric
      • CrCl 10-29: Give q24h
      • CrCl <10: Give q48h
      • HD/PD: No supplement
  • Hepatic Dosing: not defined

Contraindications

Adverse Reactions

Serious

Common

Pharmacology

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

Antibiotic Sensitivities[2]

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

References

  1. ↑ 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.
  2. ↑ Sanford Guide to Antimicrobial Therapy 2014
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