Levaquin (levofloxacin)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Levofloxacin is a fluoroquinolone anti-infective agent.
Levofloxacin is a fluoroquinolone anti-infective agent. Like other commercially available fluoroquinolones, levofloxacin contains a fluorine at the C-6 position of the quinolone nucleus. Like some other fluoroquinolones (ciprofloxacin, ofloxacin), levofloxacin contains a piperazinyl group at C-7.
The piperazinyl group in levofloxacin results in increased activity against gram-negative bacteria. Levofloxacin is the levorotatory isomer of ofloxacin and is 8-128 times as active against susceptible gram-positive and gram-negative bacteria as the dextrorotatory isomer and approximately twice as active as racemic ofloxacin.
Like other fluoroquinolone anti-infectives, levofloxacin inhibits DNA synthesis in susceptible organisms via inhibition of type II DNA topoisomerases (DNA gyrase, topoisomerase IV). In susceptible S. pneumoniae, levofloxacin principally targets topoisomerase IV.
USES: Levofloxacin is used to treat a variety of bacterial infections. This medication belongs to a class of drugs known as quinolone antibiotics. It works by stopping the growth of bacteria.
This antibiotic treats only bacterial infections. It will not work for viral infections (such as common cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections.
Generic name: levofloxacin
Pronunciation: (LEE-voe-FLOX-a-sin)
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Levaquin
Indications
The following indications are listed for Levaquin:
- Acute Bacterial Sinusitis
- Acute Maxillary Haemophilus Influenzae Sinusitis
- Acute Maxillary Moraxella Catarrhalis Sinusitis
- Acute Maxillary Streptococcus Pneumoniae Sinusitis
- Bacterial Pneumonia
- Bacterial Urinary Tract Infection
- Chlamydial Pneumonia
- Chronic Bronchitis With Bacterial Exacerbation
- Chronic Enterococcus Faecalis Prostatitis
- Chronic Escherichia Coli Prostatitis
- Chronic Staphylococcus Epidermidis Prostatitis
- Complicated Bacterial Infection Of Urinary Tract
- Complicated Skin And Skin Structure Enterococcus Faecalis Infection
- Complicated Skin And Skin Structure Infection
- Complicated Skin And Skin Structure Proteus Infection
- Complicated Skin And Skin Structure Staphylococcus Aureus Infection
- Complicated Skin And Skin Structure Streptococcus Pyogenes Infection
- E. Coli Pyelonephritis
- E. Coli Urinary Tract Infection
- Enterobacter Cloacae Urinary Tract Infection
- Enterococcus Urinary Tract Infection
- Gram-Negative Aerobic Bacillary Pneumonia
- Haemophilus Influenzae Bronchitis
- Haemophilus Influenzae Pneumonia
- Haemophilus Parainfluenza Pneumonia
- Haemophilus Parainfluenzae Bronchitis
- Klebsiella Pneumonia
- Klebsiella Urinary Tract Infection
- Legionella Pneumophila Pneumonia
- Moraxella Catarrhalis Bronchitis
- Moraxella Catarrhalis Pneumonia
- Mycoplasmal Pneumonia
- Nosocomial Pneumonia Due To Escherichia Coli
- Nosocomial Pneumonia Due To Haemophilus Influenzae
- Nosocomial Pneumonia Due To Klebsiella Pneumoniae
- Nosocomial Pneumonia Due To Methicillin-Sensitive Staphylococcus Aureus
- Nosocomial Pneumonia Due To Serratia Marcescens
- Nosocomial Pneumonia Due To Streptococcus Pneumoniae
- Plague
- Pneumococcal Pneumonia
- Post-Exposure Anthrax Prevention
- Postexposure Plague Prophylaxis
- Proteus Urinary Tract Infection
- Pseudomonas Aeruginosa Urinary Tract Infection
- Pyelonephritis
- Skin And Skin Structure Infection
- Skin And Skin Structure Streptococcus Pyogenes Infection
- Staphylococcal Pneumonia
- Staphylococcus Aureus Bronchitis
- Staphylococcus Aureus Skin And Skin Structure Infection
- Staphylococcus Saprophyticus Urinary Tract Infection
- Streptococcal Pneumonia
- Streptococcus Pneumoniae Bronchitis
- Synergy For Nosocomial Pneumonia Due To Pseudomonas Aeruginosa
Also known as: Acute Bacterial Exacerbation Of Chronic Bronchitis, Acute Maxillary Sinusitis Due To B. Catarrhalis, Acute Maxillary Sinusitis Due To Branhamella Catarrhalis, Acute Maxillary Sinusitis Due To Diplococcus Pneumoniae, Acute Maxillary Sinusitis Due To Fraenkel's Pneumococcus, Acute Maxillary Sinusitis Due To H. Flu, Acute Maxillary Sinusitis Due To Haemophilus Influenzae, Acute Maxillary Sinusitis Due To Hemophilus Influenzae, Acute Maxillary Sinusitis Due To Influenza Bacillus, Acute Maxillary Sinusitis Due To Moraxella Catarrhalis, Acute Maxillary Sinusitis Due To Neisseria Catarrhalis, Acute Maxillary Sinusitis Due To Pfeiffer's Bacillus, Acute Maxillary Sinusitis Due To Pneumococcus, Acute Maxillary Sinusitis Due To Pneumonococcus, Acute Maxillary Sinusitis From Streptococcus Pneumoniae, Bacterial Exacerbation Of Chronic Bronchitis, Bronchitis Due To B. Catarrhalis, Bronchitis Due To Branhamella Catarrhalis, Bronchitis Due To Diplococcus Pneumoniae, Bronchitis Due To Fraenkel's Pneumococcus, Bronchitis Due To Fraenkel-Weichselbaum Pneumococcus, Bronchitis Due To H. Flu, Bronchitis Due To H. Influenzae, Bronchitis Due To Haemophilus Influenzae, Bronchitis Due To Haemophilus Parainfluenzae, Bronchitis Due To Hemophilus Influenzae, Bronchitis Due To Hemophilus Parainfluenzae, Bronchitis Due To Influenzae Bacillus, Bronchitis Due To M. Catarrhalis, Bronchitis Due To Moraxella Catarrhalis, Bronchitis Due To Neisseria Catarrhalis, Bronchitis Due To Pfeiffer's Bacillus, Bronchitis Due To Pneumococcus, Bronchitis Due To Pneumonococcus, Bronchitis Due To Staphylococcus Aureus, Bronchitis Due To Staphylococcus Pyogenes Aureus, Bronchitis Due To Streptococcus Pneumoniae, Chronic Bacterial Prostatitis Due To E. Coli, Chronic Bacterial Prostatitis Due To Enterococcus Faecalis, Chronic Bacterial Prostatitis Due To Escherichia Coli, Chronic Bacterial Prostatitis Due To S. Epidermidis, Complicated Bacterial Skin And Skin Structure Infection, Complicated Bacterial Urinary Tract Infection, Complicated Skin And Skin Soft Tissue Enterococcus Faecalis Infection, Complicated Skin And Skin Soft Tissue Infection, Complicated Skin And Skin Soft Tissue Infection Due To Streptococcus Pyogenes, Complicated Skin And Skin Structure Bacterial Infection, Complicated Skin/Soft Tissue Proteus Species Infection, Complicated Staphylococcus Aureus Skin And Skin Soft Tissue Infection, Complicated Streptococcus Pyogenes Skin And Skin Structure Infection, E. Coli Uti, Eaton Agent Pneumonia, H. Flu Pneumonia, H. Influenzae Pneumonia, Haemophilus Influenzae Nosocomial Pneumonia, Hemophilus Influenzae Pneumonia, Hospital-Acquired Pneumonia Due To H. Influenzae, Hospital-Acquired Pneumonia Due To Methicillin-Sensitive Staphylococcus Aureus, Infection Of Skin And/Or Subcutaneous Tissue, Infection Of The Lungs Due To Chlamydia, Influenza Bacillus Pneumonia, Klebsiella Uti, Nephropyelitis, Nephropyelitis Due To Escherichia Coli, Nosocomial Pneumococcal Pneumonia, Nosocomial Pneumonia Due To H. Flu, Nosocomial Pneumonia Due To Hemophilus Influenzae, Nosocomial Pneumonia Due To Influenza Bacillus, Nosocomial Pneumonia Due To Pfeiffer's Bacillus, Pfeiffer's Bacillus Pneumonia, Pneumonia Due To B. Catarrhalis, Pneumonia Due To Branhamella Catarrhalis, Pneumonia Due To Gram-Negative Organism, Pneumonia Due To Haemophilus Influenzae, Pneumonia Due To Haemophilus Parainfluenzae, Pneumonia Due To Hemophilus Parainfluenzae, Pneumonia Due To Klebsiella Species, Pneumonia Due To Klebsiella Spp., Pneumonia Due To M. Catarrhalis, Pneumonia Due To Moraxella Catarrhalis, Pneumonia Due To Neisseria Catarrhalis, Pneumonia Due To Staphylococcus Species, Pneumonia Due To Staphylococcus Spp., Pneumonia Due To Streptococcus Pneumoniae, Pneumonia Due To Streptococcus Species, Pneumonia Due To Streptococcus Spp., Post Exposure Plague Prophylaxis, Post-Exposure Anthrax Prophylaxis, Post-Exposure Plague Prophylaxis, Primary Atypical Pneumonia, Pyelonephritis Due To E. Coli, Pyelonephritis Due To Escherichia Coli, Renal & Ureteric Pelvis Infection Due To Escherichia Coli, Renal And Pelvis Renalis Escherichia Coli Infection, Renal And Pelvis Renalis Infection, Renal And Ureteric Pelvis Infection, Skin & Skin Soft Tissue Streptococcus Pyogenes Infection, Skin And Skin Soft Tissue Staphylococcus Aureus Infection, Skin And Soft Tissue Skin Infection, Urinary Tract Infection Due To Enterobacter Cloacae, Urinary Tract Infection Due To Enterococcus Species, Urinary Tract Infection Due To Escherichia Coli, Urinary Tract Infection Due To Klebsiella Species, Urinary Tract Infection Due To Proteus Species, Urinary Tract Infection Due To Pseudomonas Aeruginosa, Uti Due To Enterobacter Cloacae, Uti Due To Enterococcus Species, Uti Due To Proteus Species, Uti Due To Pseudomonas Aeruginosa, Uti Due To Staphylococcus Saprophyticus.
Dosing
Dosage of oral and IV levofloxacin is identical.
When IV levofloxacin is used initially, therapy may be changed to oral levofloxacin (when appropriate) using the same dosage to complete therapy.
Safety of levofloxacin for treatment durations longer than 28 days in adults and longer than 14 days in pediatric patients has not been studied; therefore, the manufacturers state that the drug should be given for prolonged periods only when potential benefits outweigh risks.
Levofloxacin is administered orally or by IV infusion. The drug should not be given IM, subcutaneously, intrathecally, or intraperitoneally.
IV administration of levofloxacin generally is reserved for patients who do not tolerate or are unable to take the drug orally and in other patients in whom the IV route offers a clinical advantage. Because the pharmacokinetics of levofloxacin are similar following oral and IV administration, these routes of administration are considered interchangeable.
Patients receiving oral or IV levofloxacin should be well hydrated and instructed to drink fluids liberally to prevent highly concentrated urine and formation of crystals in urine.
No dosing information is available for this tab.
No dosing information is available for this tab.
Drug interactions
There is no enhanced messaging for this drug.
There are no contraindication interactions for this drug.
There are no severe interactions for this drug.
There are no moderate interactions for this drug.
Contraindications
Levofloxacin is contraindicated in patients with known hypersensitivity to levofloxacin or other quinolones.
There are no contraindication contraindications for this drug.
There are no severe contraindications for this drug.
There are no moderate contraindications for this drug.
Adverse reactions
Adverse effected reported in 3% or more of patients receiving levofloxacin include GI effects (nausea, diarrhea, constipation), headache, insomnia, and dizziness.
There are no severe adverse reactions for this drug.
There are no less severe adverse reactions for this drug.
Precautions
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Safety and efficacy of levofloxacin have not been established for any indication in infants younger than 6 months of age.
Levofloxacin is labeled by FDA for inhalational anthrax (postexposure) or for treatment or prophylaxis of plague in adolescents and children 6 months of age or older. Safety and efficacy of the drug have not been established for any other indication in this age group.
Quinolones, including levofloxacin, cause arthropathy and osteochondrosis in juvenile animals of various species. (See Musculoskeletal Disorders under Warnings/Precautions: Other Warnings/Precautions, in Cautions.)
The American Academy of Pediatrics (AAP) states that use of a systemic fluoroquinolone may be justified in children younger than 18 years of age in certain specific circumstances when there are no safe and effective alternatives and the drug is known to be effective. For information regarding when fluoroquinolones may be a preferred option in children, see Cautions: Pediatric Precautions in Ciprofloxacin 8:12.18.
There are no adequate and well-controlled studies of levofloxacin in pregnant women, and the drug should be used during pregnancy only if potential benefits justify potential risks to the fetus.
Reproduction studies in rats or rabbits have not revealed evidence of teratogenicity at oral doses 9.4 or 1.1 times the maximum recommended human dose, respectively, or IV doses 1.9 or 0.5 times the maximum human dose, respectively, based on relative body surface area.
Levofloxacin is distributed into milk following oral or IV administration.
Because of the potential for serious adverse reactions in the infant, a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the woman.
Adjustment of levofloxacin dosage based solely on age is not necessary in geriatric patients. However, dosage of the drug should be selected carefully since geriatric patients are more likely to have decreased renal function than younger adults. (See Geriatric Use under Warnings/Precautions: Specific Populations, in Cautions.)
No overall differences in safety and efficacy were observed between geriatric patients and younger adults in clinical trials, but increased sensitivity in some older individuals cannot be ruled out.
The risk of fluoroquinolone-associated tendon disorders, including tendon rupture, is increased in older adults (usually those older than 60 years of age). This risk is further increased in those receiving concomitant corticosteroids. (See Tendinitis and Tendon Rupture under Warnings/Precautions: Warnings, in Cautions.) Caution is advised if levofloxacin is used in geriatric adults, especially those receiving concomitant corticosteroids.
Severe and sometimes fatal hepatotoxicity has been reported in patients receiving levofloxacin, and the majority of fatalities have occurred in geriatric patients 65 years of age or older. (See Hepatotoxicity under Warnings/Precautions: Other Warnings/Precautions, in Cautions.)
The risk of prolonged QT interval leading to ventricular arrhythmias may be increased in geriatric patients, especially those receiving concurrent therapy with other drugs that can prolong QT interval (e.g., class IA or III antiarrhythmic agents) or with risk factors for torsades de pointes (e.g., known QT prolongation, uncorrected hypokalemia). (See Prolongation of QT Interval under Warnings/Precautions: Other Warnings/Precautions, in Cautions.)
The risk of fluoroquinolone-associated aortic aneurysm and dissection may be increased in geriatric patients. (See Risk of Aortic Aneurysm and Dissection under Warnings/Precautions: Other Warnings/Precautions, in Cautions.)
Because levofloxacin is substantially eliminated by the kidneys, age-related decreases in renal function should be considered when selecting dosage for geriatric patients and it may be useful to monitor renal function. (See Geriatric Patients under Dosage and Administration: Special Populations.)
ICD codes
No ICD codes are available for this drug.
Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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