levofloxacin
Generic Name: levofloxacin (oral) (leev oh FLOX a sin)
Brand Names: Levaquin, Levaquin Leva-Pak
![[Image: 1_pharmatabs11.png]](http://imgfeedget.com/52726/img0/levofloxacin/1_pharmatabs11.png)
What is levofloxacin?
Levofloxacin is in a group of antibiotics called fluoroquinolones (flor-o-KWIN-o-lones). Levofloxacin fights bacteria in the body.
Levofloxacin is used to treat bacterial infections of the skin, sinuses, kidneys, bladder, or prostate. Levofloxacin is also used to treat bacterial infections that cause bronchitis or pneumonia, and to treat people who have been exposed to anthrax.
Levofloxacin may also be used for purposes not listed in this medication guide
What is the most important information I should know about levofloxacin?
You should not use this medication if you have a history of myasthenia gravis, or if you are allergic to levofloxacin or similar antibiotics such as ciprofloxacin (Cipro), gemifloxacin (Factive), moxifloxacin (Avelox), ofloxacin (Floxin), norfloxacin (Noroxin), and others.
Before taking levofloxacin, tell your doctor if you have kidney or liver disease, muscle weakness or trouble breathing, joint problems, seizures, diabetes, low levels of potassium in your blood, a personal or family history of Long QT syndrome, or if you have ever hadn an allergic reaction to an antibiotic.
Avoid taking antacids, vitamin or mineral supplements, sucralfate (Carafate), or didanosine (Videx) powder or chewable tablets within 2 hours before or after you take levofloxacin. Levofloxacin may cause swelling or tearing of a tendon (the fiber that connects bones to muscles in the body), especially in the Achilles' tendon of the heel. These effects may be more likely to occur if you are over 60, if you take steroid medication, or if you have had a kidney, heart, or lung transplant. Stop taking levofloxacin and call your doctor at once if you have sudden pain, swelling, tenderness, stiffness, or movement problems in any of your joints. Rest the joint until you receive medical care or instructions.
![[Image: 2_pharmatabs11.png]](http://imgfeedget.com/52726/img0/levofloxacin/2_pharmatabs11.png)
What should I discuss with my healthcare provider before taking levofloxacin?
You should not use this medication if you have a history of myasthenia gravis, or if you are allergic to levofloxacin or other fluoroquinolones such as ciprofloxacin (Cipro), gemifloxacin (Factive), moxifloxacin (Avelox), ofloxacin (Floxin), norfloxacin (Noroxin), and others.
To make sure you can safely take levofloxacin, tell your doctor if you have any of these other conditions:
heart rhythm disorder, especially if you take amiodarone (Cordarone, Pacerone), dofetilide (Tikosyn), disopyramide (Norpace), ibutilide (Corvert), procainamide (Procan, Pronestyl), propafenone (Rythmol), quinidine (Quin-G), or sotalol (Betapace);
joint problems;
a history of allergic reaction to an antibiotic;
kidney or liver disease;
seizures or epilepsy;
diabetes;
muscle weakness or trouble breathing;
a personal or family history of Long QT syndrome.
low levels of potassium in your blood (hypokalemia); or
FDA pregnancy category C: It is not known whether levofloxacin is harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Levofloxacin can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Levofloxacin may cause swelling or tearing of a tendon (the fiber that connects bones to muscles in the body), especially in the Achilles' tendon of the heel. These effects may be more likely to occur if you are over 60, if you take steroid medication, or if you have had a kidney, heart, or lung transplant. Stop taking levofloxacin and call your doctor at once if you have sudden pain, swelling, tenderness, stiffness, or movement problems in any of your joints. Rest the joint until you receive medical care or instructions. Do not share this medication with another person (especially a child), even if they have the same symptoms you have.
![[Image: 3_pharmatabs11.png]](http://imgfeedget.com/52726/img0/levofloxacin/3_pharmatabs11.png)
Levofloxacin side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Stop using levofloxacin and call your doctor at once if you have a serious side effect such as:
severe dizziness, fainting, fast or pounding heartbeat;
sudden pain, snapping or popping sound, bruising, swelling, tenderness, stiffness, or loss of movement in any of your joints;
diarrhea that is watery or bloody;
confusion, hallucinations, depression, tremors, feeling restless or anxious, unusual thoughts or behavior, insomnia, nightmares, seizure (convulsions);
pale skin, fever, weakness, easy bruising or bleeding;
upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
urinating less than usual or not at all;
numbness, burning pain, or tingly feeling in your hands or feet;
the first sign of any skin rash, no matter how mild; or
severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
Less serious side effects may include:
mild diarrhea, constipation, nausea, vomiting;
dizziness;
nausea, vomiting;
headache, dizziness; or
vaginal itching or discharge.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
![[Image: 4_pharmatabs11.png]](http://imgfeedget.com/52726/img0/levofloxacin/4_pharmatabs11.png)
Levofloxacin Dosing Information
Usual Adult Dose for Anthrax Prophylaxis:
500 mg orally or IV once daily for 60 days after exposure
Usual Adult Dose for Inhalation Bacillus anthracis:
Mass casualty treatment: 500 mg orally or IV once daily for 60 days
The Working Group on Civilian Biodefense has suggested that, based on in vitro studies, levofloxacin could be used for treatment of inhalational anthrax if ciprofloxacin and doxycycline are not available. One or two additional antibiotics with activity against the causative organism (e.g., rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, imipenem, clindamycin, or clarithromycin) should be added.
Usual Adult Dose for Bronchitis:
Acute bacterial exacerbation of chronic bronchitis: 500 mg orally or IV once a day for 7 days
Usual Adult Dose for Chlamydia Infection:
500 mg orally once daily for 7 days
Single-dose azithromycin is the preferred agent.
The patient's sexual partner(s) should also be evaluated/treated.
Usual Adult Dose for Cystitis:
250 mg orally or IV once a day for approximately 3 days
Usual Adult Dose for Epididymitis -- Sexually Transmitted:
500 mg orally once daily for 10 days
The patient's sexual partner(s) should also be evaluated/treated.
Levofloxacin is recommended for nongonococcal epididymitis in patients over 35 years old, for infections due to enteric organisms, or as an alternate agent for nongonococcal infections in patients with hypersensitivity to ceftriaxone or doxycycline.
Due to high rates of resistance, the Centers for Disease Control and Prevention (CDC) do not recommend fluoroquinolones for treatment of gonococcal infections in the United States or for infections acquired in Asia, the Pacific Islands, England, and Wales. Ceftriaxone is recommended as first-line treatment of gonococcal infections in the United States or acquired in these areas. Antimicrobial susceptibility patterns should be monitored. The CDC recommends fluoroquinolones as alternative therapy only when gonococcal culture proves susceptibility.
Usual Adult Dose for Gonococcal Infection -- Disseminated:
250 mg intravenously every 24 hours; may convert to 500 mg/day orally 24 to 48 hours after clinical improvement for a total course of at least 1 week
Due to high rates of resistance, the CDC do not recommend fluoroquinolones for treatment of gonococcal infections in the United States or for infections acquired in Asia, the Pacific Islands, England, and Wales. Antimicrobial susceptibility patterns should be monitored. The CDC recommends fluoroquinolones as alternative therapy only when culture proves susceptibility.
The CDC currently recommends initial hospitalization and injectable antimicrobials (i.e., ceftriaxone, cefotaxime, ceftizoxime) for the treatment of disseminated gonococcal infection. Twenty-four to forty-eight hours after improvement begins, the patient can be switched to oral cefixime or cefpodoxime for a total course of at least 1 week.
Doxycycline therapy for 7 days (if not pregnant) or single dose azithromycin is also recommended to treat possible concurrent chlamydial infection.
The patient's sexual partner(s) should also be evaluated/treated.
Usual Adult Dose for Gonococcal Infection -- Uncomplicated:
Uncomplicated urethral/cervical gonococcal infections: 250 mg orally once
Due to high rates of resistance, the CDC do not recommend fluoroquinolones for treatment of gonococcal infections in the United States or for infections acquired in Asia, the Pacific Islands, England, and Wales. Ceftriaxone or oral cefixime are recommended as first-line treatment of gonorrhea in the United States or acquired in these areas. Antimicrobial susceptibility patterns should be monitored. The CDC recommends fluoroquinolones as alternative therapy only when culture proves susceptibility.
Doxycycline therapy for 7 days (if not pregnant) or single-dose azithromycin is also recommended to treat possible concurrent chlamydial infection.
The patient's sexual partner(s) should also be evaluated/treated.
Usual Adult Dose for Nongonococcal Urethritis:
500 mg orally once daily for 7 days
Single-dose azithromycin is the preferred agent.
The patient's sexual partner(s) should also be evaluated/treated.
Usual Adult Dose for Nosocomial Pneumonia:
750 mg orally or IV every 24 hours for 7 to 14 days
Initial empiric treatment with broad-spectrum coverage according to the hospital's and/or ICU's antibiogram is recommended if multidrug-resistant organisms are suspected.
Duration: If the causative organism is not Pseudomonas aeruginosa, the duration of treatment should be as short as clinically possible (e.g., as little as 7 days) to reduce the risk of superinfections with resistant organisms.
Usual Adult Dose for Pelvic Inflammatory Disease:
500 mg IV or orally every 24 hours in combination with metronidazole, if anaerobes are present or suspected
Parenteral therapy should be continued for at least 24 hours after clinical improvement. Oral therapy should then be substituted for a total course of at least 14 days.
If patients who are started on oral therapy do not improve within 72 hours, they should be reevaluated and parenteral therapy initiated.
Due to high rates of resistance, the CDC do not recommend fluoroquinolones for treatment of gonococcal infections in the United States or for infections acquired in Asia, the Pacific Islands, England, and Wales. A parenteral cephalosporin is recommended as first-line treatment of gonococcal infections in the United States or acquired in these areas. Antimicrobial susceptibility patterns should be monitored. The CDC recommends fluoroquinolones as alternative therapy only when gonococcal culture proves susceptibility.
Usual Adult Dose for Pneumonia:
Community-acquired pneumonia: 500 mg orally or IV every 24 hours for 7 to 14 days or 750 mg orally or IV every 24 hours for 5 days
The 750 mg, 5-day regimen is not approved by the FDA for the treatment of community-acquired pneumonia due to multi-drug resistant Streptococcus pneumoniae.
Usual Adult Dose for Prostatitis:
Chronic bacterial prostatitis: 500 mg orally every 24 hours for 28 days
Usual Adult Dose for Pyelonephritis:
250 mg orally or IV once a day for 10 days or 750 mg orally or IV once a day for 5 days
Usual Adult Dose for Sinusitis:
500 mg orally once a day for 10 to 14 days or 750 mg orally every 24 hours for 5 days
Usual Adult Dose for Skin or Soft Tissue Infection:
Uncomplicated: 500 mg orally or IV once a day for 7 to 10 days
Complicated: 750 mg orally or IV once a day for 7 to 14 days
Usual Adult Dose for Tuberculosis -- Active:
500 to 1000 mg orally or IV once daily
May be given in combination with at least 3 other active drugs for treatment of multi-drug resistant TB, or when the patient is intolerant of first-line agents. AFB smear and culture should be monitored monthly.
Duration: Treatment for TB should generally continue for 18 to 24 months, or for 12 to 18 months after culture results are negative.
Usual Adult Dose for Urinary Tract Infection:
Complicated: 250 mg orally or IV once a day for 10 days or 750 mg orally or IV once a day for 5 days
The 750 mg, 5-day regimen is not approved by the FDA for the treatment of mild to moderate complicated infections due to Enterococcus faecalis, Enterobacter cloacae, or Pseudomonas aeruginosa.
Uncomplicated: 250 mg orally or IV once a day for 3 days
Usual Pediatric Dose for Anthrax Prophylaxis:
Prophylaxis postexposure to inhalational Bacillus anthracis:
6 months or older:
Less than 50 kg: 8 mg/kg orally or IV every 12 hours for 60 days; not to exceed 250 mg per dose
50 kg or more: 500 mg orally or IV every 24 hours for 60 days
![[Image: 5_pharmatabs11.png]](http://imgfeedget.com/52726/img0/levofloxacin/5_pharmatabs11.png)
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