OVERVEIW OF LEVOFLOXACIN & CEFTRIAXONE

DONE BY: Ph, DIANA FAKHERDINE

LEVOFLOXACIN
 Pharmacologic category :
 Respiratory quinolones , antibiotic
 Third generation
 Use :
 Treatment of CAP
 Nosocomial pneumonia (HAP)
 Chronic bronchitis
 MDRSP
LEVOFLOXACIN
 Urinary tract infection
 Prostatitis
 Acute pyelonephritis
 M.O.A :
 inhibit DNA gyrase in susceptible organism ->inhibit
relaxation of super coiled DNA -> promote breakage of
DNA strand
 N.b DNA gyrase is a bacterial enzyme that is required
for the DNA replication , transcription , repair,
recombination and transposition
LEVOFLOXACIN
 Bacterial coverage :
 Tavanic covers gram + and anaerobes mostly ,
including listeria monocytogenes
 Covers gram – including Ecoli and enterobacter
LEVOFLOXACIN
 Side effects :
 CV: chest pain ,edema
 CNS : dizziness , headache, fatigue
 Dermatologic : rash , pruritis
 GI : nausea , diarrhea ,abdominal pain ,vomiting
 Sudden hypoglycemia
 Dosage :
 Tavanic is available as 250 mg ,500 mg vial or 500
mg (5 or 7 Tab/box)
LEVOFLOXACIN
 The dose of tavanic should be adjusted based on
patient case and creatine clearance :
Crcl >50 750 mg/day 500 mg/day 250mg/day
ml/min
Crcl 20-49 750 mg Q 48 hrs 500 mg initially No adjustment
ml/min followed by 250
mg Q 24 hrs

Crcl 10-19 750 mg initially 500 mg initially 250 mg Q 48

ml/min followed by 500 followed by 250 hrs ( except in
mg Q 48 hrs mg Q 48 hrs uncomplicated
urinary tract
infection)
LEVOFLOXACIN
 Stability :
 When diluted to 5 mg/ml in a compatible IV fluid it
is stable for 3 hrs room temperature
 Protect from light
 Administration :
 I.V solution : infuse 250 mg – 750 mg over 60-90
min since rapid infusion time can lead to
hypotension
LEVOFLOXACIN
 Avoid administration through an intavenous line
containing multivalent cat- ions ( Mg , Ca)
 Always maintain adequate hydration for the patient
to avoid crystalluria
 PO tavanic : the tablet dosage form should be taken
without meal (1 hrs before or 2 hrs after the meal)
 Also adequate hydration is needed
LEVOFLOXACIN
 In conclusion :
 Tavanic is a broad spectrum antibiotic so cant be
use as empirical therapy for all hospitalized patient
unless certain diagnosis is clearly suspected
 Within 24-48 hrs of clinically stable patient we can
switch tavanic from IV to PO route to limit patient
hospital stay
 The nurse have to monitor organ system function
(renal . Hepatic) , possibility of crystalluria ,WBC
and the sign of infection
LEVOFLOXACIN
 Should not be used in pregnancy and lactation
 Not used in children -> tendon inflammation and
rupture
 Should not be taken with antacids ( containing Ca ,
Mg) , Ca , Fe , Mg , Zn supplements )
 Adequate hydration is needed
Ceftriaxone (Rocephine)
 Pharmacologic category :
 Antibiotic , third generation cephalosporin
 Use :
 Treatment of lower respiratory tract infection
(pneumonia)
 Acute bacterial otitis media
 Skin infections
 PID (pelvic inflammatory disease)
 Uncomplicated gonorrhea
 Bacterial septicemia
Ceftriaxone (Rocephine)
 Meningitis
 Used as surgical prophylaxis
 Infected endocarditis
 M.O.A:
 Inhibit bacterial cell wall synthesis by binding to
one or more of PBPs which ->inhibits the final
transpeptidation step of peptidoglycan synthesis in
the bacterial cell wall -> inhibits cell wall
biosynthesis
Ceftriaxone (Rocephine)
 Bacterial coverage :
 Covers gram positive and gram negative including
neisseria gonorrhea / meningitides and Ecoli
Ceftriaxone (Rocephine)
 Side effects :
 GI : main SE diarrhea which occur >12 % and it is
duration dependent
 Dermatologic : diaper rash
 Endocrine & metabolic : increase in alkaline
phosphatase (ALP) and LDH
 Hematologic : eosinophilia , decrease in Hg and HCT
 Hepatic : increase in LFTs
 Local : thrombophlebitis
Ceftriaxone (Rocephine)
 Dosage :
 Infants and children :
o I.M , I.V 50-100 mg/kg/day in 1-2 divided doses
o Maximum : 4 g/day in meningitis
o 2 g /day in nonmeningeal infections
 Adults :
o I.M , I.V 1-2 every12-24 hrs
Ceftriaxone (Rocephine)
 Dosage adjustment :
 No adjustment is generally necessary BUT
concurrent hepatic and renal dysfunction maximum
dosage should be < 2 g /day

 If dialysis administer the dose post dialysis

Ceftriaxone (Rocephine)
 Stability :
 Reconstituted in D5W or NS is stable for 2 days at
room temperature and 10 days if refrigerated
 It is light sensitive medication
 If reconstituted with lidocaine for IM use it is
stable for 24 hrs room temperature
Ceftriaxone (Rocephine)
 Administration :
 Do not admix with amino glycoside in the same
bag
 Do not admix , reconstitute ,or co administer with
calcium containing solutions
 Intermittent infusion over 30 min
Ceftriaxone (Rocephine)
 Warning / precautions :
 Ceftriaxone is used with caution in patient with
previous penicillin allergy (cross allergy can take
place)
 d/c ceftraixone if gallbladder disease is suspected
 Do not use in hyperbilirubinemic neonates
 Prolonged use can result in CDAD ( clostridium
difficile associated diarrhea
Ceftriaxone (Rocephine)
 Ceftriaxone and Ca containing solution can be
administered sequentially in patients other than
neonates if the infusion line are flushed with
compatible liquid