IDStewardship

Levofloxacin (Levaquin)

Levofloxacin oral

Levofloxacin IV

 

KEY POINTS

  • Levofloxacin (Levaquin) is a fluoroquinolone antibiotic that interferes with bacterial DNA synthesis in susceptible organisms by inhbiting DNA gyrase (topoisomerase II) and topoisomerase IV
  • Possesses activity versus a variety of Gram negative bacilli, including Pseudomonas aeruginosa
    • One of the few oral antibiotics with activity versus Pseudomonas sp.
  • Considered a “respiratory fluoroquinolone” because of its activity versus Streptococcus pneuamoniae, the most common cause of community acquired pneumonia
  • Should generally be avoided for Enterococcus sp. or Staphylococcus sp. due to resistance issues
  • Possesses activity versus atypical organisms such as Legionella sp. and Mycoplasma sp.
  • Available in oral and injectable formulations
    • Oral formulation will bind to cations (e.g., calcium) so do not administer concomitantly with milk, calcium carbonate or other things that may bind to levofloxacin and prevent its absorption
  • Common dose is 250mg, 500mg or 750mg daily
    • Adjust dose/frequency for renal impairment
    • 100% bioavailable
  • A common drug to consider for the treatment of prostatitis due to it’s ability to penetrate the prostate
  • Per FDA, should only be used when benefits outweigh potential risks if treating acute sinusitis, acute bronchitis or uncomplicated urinary tract infections
  • FDA boxed warnings: tendonitis, tendon rupture, CNS effects, peripheral neuropathy, can worsen existing myasthenia gravis
  • FDA warnings: hypoglycemia (including coma), altered mental health, aortic dissection
  • Other ADRs to beware: QTC prolongation, photosensitivitity
    • Suicidal thoughts added to drug safety label warning by the FDA in February 2017

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