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Pharmacologic class: Fluoroquinolone
Therapeutic class: Anti-infective
Pregnancy risk category C
FDA Box Warning
Fluoroquinolones for systemic use are associated with an increased risk of tendinitis and tendon rupture in all ages. This risk is further increased in patients usually over age 60, with concomitant use of corticosteroids, and in kidney, heart, and lung transplant recipients.
Inhibits the enzyme DNA gyrase in susceptible gram-negative and gram-positive aerobic and anaerobic bacteria, interfering with bacterial DNA synthesis
Ophthalmic solution: Quixin-0.5% (5 mg/ml), Iquix-1.5%
Premixed solution for injection: 250 mg/50 ml, 500 mg/100 ml, 750 mg/150 ml
Solution for injection (concentrated): 500 mg/20 ml
Tablets: 250 mg, 500 mg, 750 mg
Indications and dosages
➣ Acute bacterial exacerbation of chronic bronchitis
Adults: 500 mg I.V. or P.O. q 24 hours for 7 days
➣ Community-acquired pneumonia
Adults: 500 mg I.V. or P.O. q 24 hours for 7 to 14 days, or 750 mg I.V. or P.O. q 24 hours for 5 days
➣ Nosocomial pneumonia caused by methicillin-susceptible strains of Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, or Streptococcus pneumoniae; complicated skin and skin-structure infections
Adults: 750 mg I.V. or P.O. q 24 hours for 7 to 14 days
➣ Acute bacterial sinusitis caused by S. pneumoniae, H. influenzae, or Moraxella catarrhalis
Adults: 500 mg I.V. or P.O. q 24 hours for 10 to 14 days or 750 mg P.O. or I.V. q 24 hours for 5 days
➣ Uncomplicated skin and skin-structure infections
Adults: 500 mg I.V. or P.O. q 24 hours for 7 to 10 days
➣ Complicated urinary tract infections; acute pyelonephritis caused by E. coli
Adults: 250 mg I.V. or P.O. q 24 hours for 10 days or 750 mg P.O. or I.V. q 24 hours for 5 days
➣ Uncomplicated urinary tract infections
Adults: 250 mg I.V. or P.O. q 24 hours for 3 days
➣ Chronic bacterial prostatitis
Adults: 500 mg I.V. or P.O. q 24 hours for 28 days.
Adults and children ages 1 and older: One or two drops of 0.5% ophthalmic solution into affected eye q 2 hours while awake on days 1 and 2 (up to eight times daily); then one or two drops q 4 hours while awake on days 3 through 7 (up to four times daily)
➣ Corneal ulcers
Adults and children ages 6 and older: On days 1 to 3, one or two drops of 1.5% ophthalmic solution instilled into affected eye(s) q 30 minutes to 1 hour while awake and q 4 to 6 hours after retiring; thereafter, one or two drops q 1 to 4 hours while awake until treatment completion
➣ Inhalational anthrax (postexposure)
Adults and children ages 6 months and older weighing more than 50 kg (110 lb): 500 mg P.O. or I.V. q 24 hours for 60 days
Children ages 6 months and older weighing less than 50 kg (110 lb): 8 mg/kg P.O. or I.V., not to exceed 250 mg/dose q 12 hours for 60 days
• Renal impairment
• Hypersensitivity to drug, its components, or other quinolones
Use cautiously in:
• bradycardia, acute myocardial ischemia, prolonged QTc interval, cirrhosis, renal impairment, underlying CNS disease, uncorrected hypocalcemia
• elderly patients
• pregnant or breastfeeding patients
• children younger than age 18 (except in ophthalmic use).
• Be aware that oral and I.V. dosages are identical.
• Give parenteral form by I.V. route only. Drug isn't for I.M., subcutaneous, intrathecal, or intraperitoneal use.
• To prepare I.V. infusion, use compatible solution, such as 0.9% sodium chloride injection, dextrose 5% and 0.9% sodium chloride injection, dextrose 5% in water, or dextrose 5% in lactated Ringer's solution.
• Infuse over 60 to 90 minutes, depending on dosage. Don't infuse with other drugs.
☞ Avoid rapid or bolus I.V. administration, because this may cause severe hypotension
• Flush I.V. line before and after infusion.
• Give oral doses 2 hours before or after sucralfate, iron, antacids containing magnesium or aluminum, or multivitamins with zinc.
• Give oral form without regard to food, but don't give with milk or yogurt alone.
• Be aware that the two ophthalmic preparations have different indications.
CNS: dizziness, headache, insomnia, seizures
CV: chest pain, palpitations, hypotension
EENT: photophobia, sinusitis, pharyngitis
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, flatulence, pseudomembranous colitis
Metabolic: hyperglycemia, hypoglycemia
Musculoskeletal: back pain, tendon rupture, tendinitis
Other: altered taste, reaction and pain at I.V. site, hypersensitivity reactions including Stevens-Johnson syndrome
Drug-drug. Antacids containing aluminum or magnesium, didanosine (tablets), iron salts, sucralfate, zinc salts: decreased levofloxacin absorption
Cimetidine: interference with levofloxacin elimination
Nonsteroidal anti-inflammatory drugs: increased risk of CNS stimulation and seizures
Drug-diagnostic tests. Glucose: increased or decreased level
Lymphocytes: decreased count
EEG: abnormal findings
Drug-food. Concurrent tube feedings, milk, yogurt: impaired levofloxacin absorption
Drug-herbs. Dong quai, St. John's wort: phototoxicity
Fennel: decreased levofloxacin absorption
Drug-behaviors. Sun exposure: phototoxicity
• Check vital signs, especially blood pressure. Too-rapid infusion can cause hypotension.
• Closely monitor patients with renal insufficiency.
• Monitor blood glucose level closely in diabetic patients.
☞ Assess for severe diarrhea, which may indicate pseudomembranous colitis.
☞ Watch for hypersensitivity reaction. Discontinue drug immediately if rash or other signs or symptoms occur.
☞ Watch for signs and symptoms of tendinitis or tendon rupture.
☞ Tell patient to stop taking drug and contact prescriber if he experiences signs or symptoms of hypersensitivity reaction (rash, hives, or other skin reactions) or severe diarrhea (which may indicate pseudomembranous colitis).
☞ Instruct patient to stop taking drug and notify prescriber immediately if tendon pain, swelling, or inflammation occurs.
• Instruct patient not to take with milk, yogurt, multivitamins containing zinc or iron, or antacids containing aluminum or magnesium.
• Teach patient proper use of eye drops. Tell him to avoid touching applicator tip to eye, finger, or any other object.
• Caution patient to avoid driving and other activities that require mental alertness until CNS effects of drug are known.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.