Lower respiratory infection (CAP, HAP)
Levofloxacin crosses the placenta.
There is very limited data on levofloxacin use during pregnancy.
In general, fluoroquinolone use during pregnancy has not been associated with congenital malformations or evidence of cartilage damage or tendon rupture in newborns. Fluoroquinolones and their effect on joint development are still being studied.
Fluoroquinolones should only be used during pregnancy in the absence of other alternatives to treat the infection.
No clinical data on the use of levofloxacin and effects on infants have been reported.
A single report on the levels of levofloxacin in breastmilk following maternal usage during lactation reported low concentrations.
Use of levofloxacin is likely acceptable in breastfeeding with monitoring of the infant for possible effects on the gastrointestinal flora, such as diarrhea.
As per any use of fluoroquinolones in any population, alternatives should be used where available.
Maternal use of an eye drop that contains levofloxacin presents negligible risk for the nursing infant.
Monitor QTc in patients with increased risk.
CNS toxicity including confusion, psychosis
Tendinopathy and rupture
Weakness exacerbation in myasthenia gravis
Other QTc prolonging agents
Di- & Trivalent cations including Al, Ca, Fe, Mg (antacids, dairy products, iron supplements, some enteral feeds) - decreased absorption
NSAIDs - may enhance the neuroexcitatory and/or seizure-potentiating effect of quinolones. Nonsteroidal anti-inflammatory agents may increase the serum concentration of quinolones.
Warfarin - increased INR
Concurrent use of steroids may increase the risk of tendon rupture for patients at risk
FDA Black Box warning against use in uncomplicated UTI, acute bacterial sinusitis, and acute exacerbation of chronic bronchitis where alternatives exist due to serious adverse side effects.
May exacerbate muscle weakness in persons with myasthenia gravis. Avoid Use.
Antimicrobial class: Fluoroquinolone.