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 suscep
tible gram-negative and gram-positive bacteria, preventing cell reproduction.
Indications
Treatment of adults with community-acquired pneumonia, acute maxillary si
nusitis caused by susceptible bacteria, including multidrug resistant strains
Treatment of acute exacerbation of chronic bronchitis caused by susceptib
le bacteria
Treatment of complicated and uncomplicated skin and skin structure infect
ions 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, Enter
ococcus faecalis, Staphylococcus
Treatment of nosocomial pneumonia due to methicillin-sensitive Staphyloco
ccus aureus, Pseudomonas strains, Serratia species, Escherichia coli, Klebsiella
, Haemophilus influenzae, Streptococcus pneumoniae
Unlabeled uses: Anthrax, traveler's diarrhea, epididymitis, gonococcal in
fection, pelvic inflammatory disease, urethritis
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;
oral solution 25 mg/mL
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 14 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 500 mg/day by slow IV in
fusion over 90 min for 28 days.
PEDIATRIC PATIENTS
Not recommended in patients < 18 yr.
PATIENTS WITH RENAL IMPAIRMENT
Creatinine Clearance (mL/min) Dose
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 (mL/min) Dose
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; di
lute single-use vials in 50 100 mL D5W.
Infusion: Administer slowly over at least 60 90 min. Do not administer IM or subcu
taneously.
Compatibilities: Can be further diluted in 0.9% sodium chloride injection, 5% de
xtrose injection, 5% dextrose/0.9% sodium chloride, 5% dextrose in lactated Ring
er's, Plasma-Lyte 56 and 5% Dextrose injection, 9% dextrose/0.45% sodium chlorid
e, 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 wit
h this drug than with oflaxacin), constipation, flatulence
Hematologic: Elevated BUN, AST, ALT, serum creatinine, and alkaline phosp
hatase; neutropenia, anemia
Other: Fever, rash, photosensitivity, muscle and joint tenderness, increa
sed serum glucose
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, lactat
ion, pregnancy
Physical: Skin color, lesions; T; orientation, reflexes, affect; mucous m
embranes, bowel sounds; renal and liver function tests; blood glucose (diabetics
)
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 wate
r; separate oral drug from other cation administration, including antacids, by a
t least 2 hr.
Ensure that patient is well hydrated during course of therapy.
WARNING: Discontinue drug at any sign of hypersensitivity (rash, photopho
bia) 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 a
n antacid is needed, do not take it within 2 hr of levofloxacin dose.
Drink plenty of fluids while you are using this drug.
You may experience these side effects: 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 dan
gerous equipment); sensitivity to sunlight (avoid exposure, use a sunscreen if n
ecessary).
Report rash, visual changes, severe GI problems, weakness, tremors.
Adverse effects in Italic are most common; those in Bold are life-threatening.