Levofloxacin

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General

  • Type: Fluoroquinolone
  • Dosage Forms: PO, IV, Inhaled
  • 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
      • 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

Authors:

Ross Donaldson