Levofloxacin

Indications
 Oral
Acute bacterial sinusitis
Adult: 500 mg once daily for 10-14 days. Alternatively, 750 mg once daily for 5 days.
Renal impairment: Haemodialysis/CAPD: Initially, 500 mg daily, then 250 mg every 48 hr. Alternatively: Initially, 750 mg daily, then 500 mg every 48 hr.
CrCl (ml/min)Dosage Recommendation
20-49Initially, 500 mg daily, then 250 mg every 24 hr. Alternatively: Initially, 750 mg daily, then 750 mg every 48 hr.
10-19Initially, 500 mg daily, then 250 mg every 48 hr. Alternatively: Initially, 750 mg daily, then 500 mg every 48 hr.

Oral
Acute bacterial exacerbation of chronic bronchitis
Adult: 500 mg once daily for 7 days.
Renal impairment: Haemodialysis/CAPD: Initially, 500 mg daily, then 250 mg every 48 hr.
CrCl (ml/min)Dosage Recommendation
20-49Initially, 500 mg daily, then 250 mg every 24 hr.
10-19Initially, 500 mg daily, then 250 mg every 48 hr.

Oral
Community-acquired pneumonia
Adult: 500 mg once for 7-14 days. Alternatively, 750 mg once daily for 5 days.
Renal impairment: Haemodialysis/CAPD: Initially, 500 mg daily, then 250 mg every 48 hr. Alternatively: Initially, 750 mg daily, then 500 mg every 48 hr.
CrCl (ml/min)Dosage Recommendation
20-49Initially, 500 mg daily, then 250 mg every 24 hr. Alternatively: Initially, 750 mg daily, then 750 mg every 48 hr.
10-19Initially, 500 mg daily, then 250 mg every 48 hr. Alternatively: Initially, 750 mg daily, then 500 mg every 48 hr.

Oral
Nosocomial pneumonia
Adult: 750 mg once daily for 7-14 days.
Renal impairment: Haemodialysis/CAPD: Initially, 750 mg daily, then 500 mg every 48 hr.
CrCl (ml/min)Dosage Recommendation
20-49Initially, 750 mg daily, then 750 mg every 48 hr.
10-19Initially, 750 mg daily, then 500 mg every 48 hr.

Oral
Complicated skin and skin structure infections
Adult: 750 mg once daily for 7-14 days.
Renal impairment: Haemodialysis/CAPD: Initially, 750 mg daily, then 500 mg every 48 hr.
CrCl (ml/min)Dosage Recommendation
20-49Initially, 750 mg daily, then 750 mg every 48 hr.
10-19Initially, 750 mg daily, then 500 mg every 48 hr.

Oral
Uncomplicated urinary tract infections
Adult: 250 mg once daily for 3 days.
Oral
Complicated urinary tract infections
Adult: 250 mg once daily for 10 days.
CrCl (ml/min)Dosage Recommendation
10-19Initially 250 mg daily, then 250 mg every 48 hr.

Oral
Acute pyelonephritis
Adult: 250 mg once daily for 10 days.
CrCl (ml/min)Dosage Recommendation
10-19Initially 250 mg daily, then 250 mg every 48 hr.

Oral
Uncomplicated skin and skin structure infections
Adult: 500 mg once daily for 7-10 days.
Renal impairment: Haemodialysis/CAPD: Initially, 500 mg daily, then 250 mg every 48 hr.
CrCl (ml/min)Dosage Recommendation
20-49Initially, 500 mg daily, then 250 mg every 24 hr.
10-19Initially, 500 mg daily, then 250 mg every 48 hr.

Oral
Chronic bacterial prostatitis
Adult: 500 mg once daily for 28 days.
Renal impairment: Haemodialysis/CAPD: Initially, 500 mg daily, then 250 mg every 48 hr.
CrCl (ml/min)Dosage Recommendation
20-49Initially, 500 mg daily, then 250 mg every 24 hr
10-19Initially, 500 mg daily, then 250 mg every 48 hr.

Oral
Treatment and postexposure prophylaxis of inhalation anthrax
Adult: 500 mg once daily for 60 days.
Renal impairment: Haemodialysis/CAPD: Initially, 500 mg daily, then 250 mg every 48 hr.
CrCl (ml/min)Dosage Recommendation
20-49Initially, 500 mg daily, then 250 mg every 24 hr.
10-19Initially, 500 mg daily, then 250 mg every 48 hr.

Intravenous
Acute bacterial sinusitis
Adult: 500 mg once daily for 10-14 days. Alternatively, 750 mg once daily for 5 days. Infuse slowly over 60-90 min.
Renal impairment: Haemodialysis/CAPD: Initially, 500 mg daily, then 250 mg every 48 hr. Alternatively: Initially, 750 mg daily, then 500 mg every 48 hr. Infuse slowly over 60-90 min.
CrCl (ml/min)Dosage Recommendation
20-49Initially, 500 mg daily, then 250 mg every 24 hr. Alternatively: Initially, 750 mg daily, then 750 mg every 48 hr.
10-19Initially, 500 mg daily, then 250 mg every 48 hr. Alternatively: Initially, 750 mg daily, then 500 mg every 48 hr.

Intravenous
Acute bacterial exacerbation of chronic bronchitis
Adult: 500 mg once daily for 7 days. Infuse slowly over 60 min.
Renal impairment: Haemodialysis/CAPD: Initially, 500 mg daily, then 250 mg every 48 hr. Infuse slowly over 60-90 min.
CrCl (ml/min)Dosage Recommendation
20-49Initially, 500 mg daily, then 250 mg every 24 hr.
10-19Initially, 500 mg daily, then 250 mg every 48 hr.

Intravenous
Community-acquired pneumonia
Adult: 500 mg once for 7-14 days. Alternatively, 750 mg once daily for 5 days. Infuse slowly over 60-90 min.
Renal impairment: Haemodialysis/CAPD: Initially, 500 mg daily, then 250 mg every 48 hr. Alternatively: Initially, 750 mg daily, then 500 mg every 48 hr. Infuse slowly over 60-90 min.
CrCl (ml/min)Dosage Recommendation
20-49Initially, 500 mg daily, then 250 mg every 24 hr. Alternatively: Initially, 750 mg daily, then 750 mg every 48 hr.
10-19Initially, 500 mg daily, then 250 mg every 48 hr. Alternatively: Initially, 750 mg daily, then 500 mg every 48 hr.

Intravenous
Nosocomial pneumonia
Adult: 750 mg once daily for 7-14 days. Infuse slowly over 60-90 min.
Renal impairment: Haemodialysis/CAPD: Initially, 750 mg daily, then 500 mg every 48 hr. Infuse slowly over 60-90 min.
CrCl (ml/min)Dosage Recommendation
20-49Initially, 750 mg daily, then 750 mg every 48 hr.
10-19Initially, 750 mg daily, then 500 mg every 48 hr.

Intravenous
Complicated skin and skin structure infections
Adult: 750 mg once daily for 7-14 days. Infuse slowly over 60-90 min.
Renal impairment: Haemodialysis/CAPD: Initially, 750 mg daily, then 500 mg every 48 hr. Infuse slowly over 60-90 min.
CrCl (ml/min)Dosage Recommendation
20-49Initially, 750 mg daily, then 750 mg every 48 hr.
10-19Initially, 750 mg daily, then 500 mg every 48 hr.

Intravenous
Uncomplicated urinary tract infections
Adult: 250 mg once daily for 3 days. Infuse slowly over 60-90 min.
Intravenous
Complicated urinary tract infections
Adult: 250 mg once daily for 10 days. Infuse slowly over 60-90 min.
CrCl (ml/min)Dosage Recommendation
10-19Initially 250 mg daily, then 250 mg every 48 hr.

Intravenous
Acute pyelonephritis
Adult: 250 mg once daily for 10 days. Infuse slowly over 60-90 min.
CrCl (ml/min)Dosage Recommendation
10-19Initially 250 mg daily, then 250 mg every 48 hr.

Intravenous
Uncomplicated skin and skin structure infections
Adult: 500 mg once daily for 7-10 days. Infuse slowly over 60-90 min.
Renal impairment: Haemodialysis/CAPD: Initially, 500 mg daily, then 250 mg every 48 hr. Infuse slowly over 60-90 min.
CrCl (ml/min)Dosage Recommendation
20-49Initially, 500 mg daily, then 250 mg every 24 hr.
10-19Initially, 500 mg daily, then 250 mg every 48 hr.

Intravenous
Chronic bacterial prostatitis
Adult: 500 mg once daily for 28 days. Infuse slowly over 60-90 min.
Renal impairment: Haemodialysis/CAPD: Initially, 500 mg daily, then 250 mg every 48 hr. Infuse slowly over 60-90 min.
CrCl (ml/min)Dosage Recommendation
20-49Initially, 500 mg daily, then 250 mg every 24 hr.
10-19Initially, 500 mg daily, then 250 mg every 48 hr.

Intravenous
Treatment and postexposure prophylaxis of inhalation anthrax
Adult: 500 mg once daily for 60 days. Infuse slowly over 60-90 min.
Renal impairment: Haemodialysis/CAPD: Initially, 500 mg daily, then 250 mg every 48 hr. Infuse slowly over 60-90 min.
CrCl (ml/min)Dosage Recommendation
20-49Initially, 500 mg daily, then 250 mg every 24 hr.
10-19Initially, 500 mg daily, then 250 mg every 48 hr.

Ophthalmic
Ocular infections
Adult: 1-2 drops of 0.5% solution every 2 hr while awake (up to 8 times daily) for 2 days, then 1-2 drops every 4 hr while awake (up to 4 times daily) for the next 5 days.
Child: >1 yr: 1-2 drops of 0.5% solution every 2 hr while awake (up to 8 times daily) for 2 days, then 1-2 drops every 4 hr while awake (up to 4 times daily) for the next 5 days.

Special Populations: For patients with CrCl of 20-49 mL/min, the initial dose of 500 mg is administered followed by 250 mg once daily. If CrCl is 10-19 mL/min, the initial dose of 500 mg is administered followed by 250 mg every 48 hours. Reduce dose in patients with renal impairment.
Contraindications
 Hypersensitivity to levofloxacin or other quinolones. Child <18 yr.
Warnings / Precautions
 Known or suspected CNS disorders (e.g. severe cerebral arteriosclerosis, epilepsy) or other risk factors that predispose to seizures. Avoid unnecessary exposure to sunlight or artificial UV light. History of prolonged QT interval, uncorrected electrolyte disturbances. DM (carefully monitor blood glucose levels). Periodically monitor renal, hepatic and haematopoietic functions during treatment. Pregnancy and lactation. Elderly. May impair ability to drive or operate machinery.
Adverse Reactions
 Oral/IV: Nausea, diarrhoea, constipation, headache, insomnia, inj site reactions (IV). Ophthalmic: Transient decrease in vision, ocular burning, ocular pain or discomfort, foreign body sensation, headache, fever, pharyngitis, photophobia.
Potentially Fatal: Anaphylaxis.
Drug Interactions
 Increased concentration of ciclosporin or tacrolimus. Reduced absorption with didanosine, ferrous sulfate or dietary supplements containing zinc, calcium, magnesium or iron. May increase plasma levels of theophylline. Increased risk of tendon rupture with corticosteroids. Reduced absorption with sucralfate and antacids containing magnesium and aluminium; administer at least 2 hr before or 2 hr after antacids. Increased half-life and decreased clearance of procainamide. Altered glucose levels with antidiabetic agents (e.g. insulin, glyburide).
Potentially Fatal: Increased risks of ventricular arrhythmias with QT prolonging drugs e.g. class IA (quinidine, procainamide) or class III (amiodarone, sotalol) antiarrhythmics, fluoxetine, imipramine. Increased risk of CNS stimulation and seizures with NSAIDs. Increased prothrombin time with warfarin.
See Below for More levofloxacin Drug Interactions
Lab Interactions
 False-positive tests for opiates.
Mechanism of Actions
 Levofloxacin exerts antibacterial action by inhibiting bacterial topoisomerase IV and DNA gyrase, the enzymes required for DNA replication, transcription repair and recombination. It has in vitro activity against a wide range of gram-negative and gram-positive microorganisms.
Absorption: Rapid and complete absorption from the GIT (oral); peak plasma concentrations within 1-2 hr.
Distribution: Widely distributed in bronchial mucosa, lungs; CSF (relatively poor). Protein-binding: 30-40%.
Metabolism: Limited.
Excretion: Mainly via urine (largely as unchanged drug); 6-8 hr (elimination half-life).
Administration
 Tab: May be taken with or without food. (Ensure adequate fluid intake.)
Oral soln: Should be taken on an empty stomach. (Take on an empty stomach 1 hr before or 2 hr after meals. Ensure adequate fluid intake.)
Storage Conditions
 Intravenous: Store below 25°C (77°F). Ophthalmic: Store at 15-25°C (59-77°F). Oral: Tablet: Store at 15-30°C (59-86°F). Oral solution: Store at 25°C (77°F).
ATC Classification
 J01MA12 - levofloxacin ; Belongs to the class of fluoroquinolones. Used in the systemic treatment of infections.
S01AX19 - levofloxacin ; Belongs to the class of other antiinfectives. Used in the treatment of eye infections.
Storage
 Intravenous: Store below 25°C (77°F). Ophthalmic: Store at 15-25°C (59-77°F). Oral: Tablet: Store at 15-30°C (59-86°F). Oral solution: Store at 25°C (77°F).
Available As
  • Levofloxacin 0.3%
  • Levofloxacin 0.5%
  • Levofloxacin 0.5% w/v
  • Levofloxacin 1.5%
  • Levofloxacin 1000 mg
  • Levofloxacin 125 mg
  • Levofloxacin 15 mg
  • Levofloxacin 200 mg
  • Levofloxacin 250 mg
  • Levofloxacin 5 mg
  • Levofloxacin 50 mg
  • Levofloxacin 500 mg
  • Levofloxacin 750 mg

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