Levofloxacin

C difficile risk
High
Oral Bioavailability
Excellent

Dosing

500 - 750mg PO/IV daily

0 - 20 eGFR20 - 50 eGFR50+ eGFR750 mg IV/PO load then 500 mg IV/PO q48h500 - 750 mg IV/PO q48h500 - 750 mg IV/PO daily

General Information

  • Lower respiratory infection (CAP, HAP)

  • Intraabdominal infection

  • UTI

Pregnancy:

  • 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.

Breastfeeding:

  • 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.

  • QTc prolongation

  • Dysglycemia

  • CNS toxicity including confusion, psychosis

  • Tendinopathy and rupture

  • GI upset

  • Weakness exacerbation in myasthenia gravis

  • Rash

  • 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.