levofloxacin

(lee voe flox' a sin)

Levaquin

Pregnancy Category C

Drug classes
Antibiotic
Fluoroquinolone

Therapeutic actions
Bactericidal: Interferes with DNA by inhibiting DNA synase replication in susceptible
gram-negative and gram-positive bacteria, preventing cell reproduction.

Indications
• Treatment of adults with community-acquired pneumonia, acute maxillary
sinusitis caused by susceptible bacteria
• Treatment of acute exacerbation of chronic bronchitis caused by susceptible
bacteria
• Treatment of complicated and uncomplicated skin and skin structure infections
caused by susceptible bacteria
• Treatment of complicated and uncomplicated UTIs and acute pyelonephritis
caused by susceptible bacteria
• Treatment of chronic bacterial prostatitis due to Escherichia coli, Enterococcus
faecalis, Staphylococcus species
• Treatment of nosocomial pneumonia due to methicillin-sensitive Staphylococcus
aureus, Pseudomonas strains, Serratia species, Escherichia coli, Klebsiella
species, Haemophilus influenzae, Streptococcus pneumoniae

Contraindications and cautions

• Contraindicated with allergy to fluoroquinolones, lactation.
• Use cautiously with renal dysfunction, seizures, pregnancy.

Available forms
Tablets—250, 500, 750 mg; injection—500, 750 mg; premixed injection—250, 500,
750 mg

Dosages
ADULTS
• Pneumonia: 500 mg daily PO or IV for 7–14 days.
• Sinusitis: 500 mg daily PO or IV for 10–14 days.
• Chronic bronchitis: 500 mg daily PO or IV for 7 days.
• Skin infection: 500–750 mg daily PO or IV for 7–10 days.
• UTIs: 250 mg daily PO or IV for 3–10 days.
• Pyelonephritis: 250 mg daily PO or IV for 10 days.
 • Nosocomial pneumonia: 750 mg daily PO or IV for 7–14 days.
• Chronic prostatitis: 50 mg/day PO for 28 days or 50 mg/day by slow IV infusion
over 90 min for 28 days.
PEDIATRIC PATIENTS
Not recommended in patients < 18 yr.
PATIENTS WITH RENAL IMPAIRMENT
Creatinine Clearance Dose
(mL/min)
50–80 No adjustment
20–49 500 mg initially, then 250 mg daily
10–19 500 mg initially, then 250 mg q 48 hr
• Chronic prostatitis:
Creatinine Clearance Dose
(mL/min)
50–80 No adjustment
20–49 250 mg daily
10–19 250 mg q 48 hr
For patients on hemodialysis, use 250 mg q 48 hr.

Pharmacokinetics
Route Onset Peak Duration
Oral Varies 1–2 hr 3–5 hr
IV Rapid End of infusion 3–5 hr

Metabolism: Hepatic; T1/2: 4–7 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

IV facts
Preparation: No further preparation is needed if using the premixed solution; dilute
single-use vials in 50–100 mL D5W.
Infusion: Administer slowly over at least 60–90 min. Do not administer IM or SC.
Compatibilities: Can be further diluted in 0.9% sodium chloride injection, 5% dextrose
injection, 5% dextrose/0.9% sodium chloride, 5% dextrose in lactated Ringer's, Plasma-
Lyte 56 and 5% Dextrose injection, 9% dextrose/0.45% sodium chloride, 0.15%
potassium chloride, sodium lactate injection.

Adverse effects
• CNS: Headache, dizziness, insomnia, fatigue, somnolence, blurred vision
• GI: Nausea, vomiting, dry mouth, diarrhea, abdominal pain (occur less with this
drug than with oflaxacin), constipation, flatulence
• Hematologic: Elevated BUN, AST, ALT, serum creatinine, and alkaline
phosphatase; neutropenia, anemia
• Other: Fever, rash, photosensitivity, muscle and joint tenderness

Interactions
Drug-drug
• Decreased therapeutic effect with iron salts, sulcrafate, antacids, zinc, magnesium
(separate by at least 2 hr)
• Increased risk of seizures with NSAIDs; avoid this combination
Drug-alternative therapy
• Increased risk of severe photosensitivity reactions if combined with St. John's
wort therapy

Nursing considerations
Assessment
• History: Allergy to fluoroquinolones, renal dysfunction, seizures, lactation,
pregnancy
• Physical: Skin color, lesions; T; orientation, reflexes, affect; mucous membranes,
bowel sounds; renal and liver function tests

Interventions
• Arrange for culture and sensitivity tests before beginning therapy.
• Continue therapy as indicated for condition being treated.
• Administer oral drug 1 hr before or 2 hr after meals with a glass of water; separate
oral drug from other cation administration, including antacids, by at least 2 hr.
• Ensure that patient is well hydrated during course of therapy.
• Discontinue drug at any sign of hypersensitivity (rash, photophobia) or at
complaint of tendon pain, inflammation, or rupture.
• Monitor clinical response; if no improvement is seen or a relapse occurs, repeat
culture and sensitivity test.

Teaching points
• Take oral drug on an empty stomach, 1 hr before or 2 hr after meals. If an antacid
is needed, do not take it within 2 hr of levofloxacin dose.
• Drink plenty of fluids while you are using this drug.
• These side effects may occur: Nausea, vomiting, abdominal pain (eat frequent
small meals); diarrhea or constipation (consult nurse or physician); drowsiness,
blurred vision, dizziness (use caution if driving or operating dangerous
equipment); sensitivity to sunlight (avoid exposure, use a sunscreen if necessary).
• Report rash, visual changes, severe GI problems, weakness, tremors.

Adverse effects in Italic are most common; those in Bold are life-threatening.