Infectious Disease Compendium

Levofloxacin (Levaquin®)

Dosing

CrCl Formula

CrCl > 80: 750 - 500 mg po/iv q 24 h.

CrCl 80-50:

CrCl 50-10: 250 mg iv/po q 24 h.

CrCl < 10: 250 mg iv/po q 48 h.

Hemodialysis:

Peritoneal dialysis:

Important side effects

May be the quinolone most likely to cause tendonopathy (Pubmed).

Decreased or blurred vision (ophthalmic solution), diarrhea,, headache, hyperglycemia, hypoglycemia (usually in diabetic patients), injection site reactions, nausea, peripheral neuropathy, severe hypersensitivity reactions (rare), tendon rupture (rare), torsades de pointes (rare). Diplopia (PubMed).

Maybe retinal detachment (PubMed). Or not (PubMed). Probably for rhegmatogenous retinal detachment (PubMed).

Liver disease in the elderly (about 6 in 100,000) (PubMed).

Can double the risk of acute kidney injury (PubMed).

Arrhythmias: "Gatifloxacin use was associated with the highest rate (RR = 7.38; 95% CI, 2.30-23.70); moxifloxacin and ciprofloxacin were also associated with elevated rates of serious arrhythmia (RR = 3.30; 95% CI, 1.47-7.37 and RR = 2.15; 95% CI, 1.34-3.46, respectively)" (PubMed). Not so much with levofloxicin.

Important drug interactions

As with all quinolones, oral divalent cations will bind the drug and prevent absorption. aluminum carbonate, basic, aluminum hydroxide, aluminum phosphate, antidiabetic agents, calcium, class ia antiarrhythmic agents, class iii antiarrhythmic agents, corticosteroids, didanosine, dihydroxyaluminum aminoacetate, dihydroxyaluminum sodium carbonate, iron, magaldrate, magnesium carbonate, magnesium hydroxide, magnesium oxide, magnesium trisilicate, mesoridazine, nonsteroidal antiinflammatory agents, phenothiazines, sucralfate, theophylline, thioridazine, typhoid vaccine, warfarin, zinc, ziprasidone.

Rants and Screeds

Pearls

As with all quinolones, oral divalent cations will bind the drug and prevent absorption.

Treatment of choice

Use for

Anthrax - postexposure prophylaxis, Cellulitis, Bronchitis-chronic, Conjunctivitis, corneal ulcer, enteritis, gynecological infections, Diarrhea, meningitis - tuberculous, Otitis media, Pneumonia, Prostatitis, Sexually Transmitted Diseases, Sinusitis, surgical infections, Tuberculosis, UTI.

Don't use for

For me Pseudomonas and I do not trust it for streptococci or staphylococci. But that's me. Sometime in 2005 the IDSA had a supplement about promoting levofloxacin and Pseudomonas; are they in the pockets of the drug companies or what? It is so depressing. www.nofreelunch.org.

Class

Quinolone.