LEVOFLOXACIN

(lev-o-flox'a-sin)
Levaquin, Iquix, Quixin
Classifications: antiinfective; antibiotic; quinolone
Prototype: Ciprofloxacin
Pregnancy Category: C

Availability
250 mg, 500 mg tablets; 250 mg, 500 mg injection; 0.5% ophthalmic solution

Actions
A broad-spectrum fluoroquinolone antibiotic that inhibits DNA bacterial topoisomerase
II, an enzyme required for DNA replication, transcription, repair, and recombination.

Therapeutic Effects
Prevents replication of certain bacteria resistant to beta-lactam antibiotics.

Uses
Treatment of maxillary sinusitis, acute exacerbations of bacterial bronchitis, community-
acquired pneumonia, uncomplicated skin/skin structure infections, UTI, acute
pyelonephritis caused by susceptible bacteria; chronic bacterial prostatitis; bacterial
conjunctivitis.

Contraindications
Hypersensitivity to levofloxacin and quinolone antibiotics; hypokalemia, tendon pain,
pregnancy (category C); syphilis; viral infections; phototoxicity; lactation.

Cautious Use
Known or suspected CNS disorders predisposed to seizure activity (e.g., severe cerebral
atherosclerosis), risk factors associated with potential seizures (e.g., some drug therapy,
renal insufficiency), dehydration, colitis; QT prolongation, cardiac arrhythmias; renal
impairment; diabetes; patients receiving theophylline or caffeine; older adults. Safety and
efficacy in children <18 y are not established.
Route & Dosage

Infections
Adult: PO 500 mg q24h x 10 d IV 500 mg infused over 60 min q24h x 7–14 d

Community-Acquired Pneumonia
Adult: PO/IV 750 mg q24h x 5 d

Uncomplicated UTI
Adult: PO 250 mg q24h x 14 d

Complicated UTI, Pyelonephritis

Adult: PO 250 mg q24h x 10 d IV 250 mg infused over 60 min q24h x 10 d

Chronic Bacterial Prostatitis

Adult: PO 500 mg q24h x 28 d

Renal Impairment
Give an initial dose of 500 mg with adjusted maintenance doses as follows; Clcr 20–50
mg/min: 250 mg q24h; <20 mL/min: 250 mg q48h

Skin & Skin Structure Infections

Adult: PO 750 mg q24h x 14 d

Renal Impairment
Give an initial dose of 250 mg with adjusted maintenance doses as follows; Clcr <20
mL/min: 250 mg q48h

Bacterial Conjunctivitis
Adult: Ophthalmic days 1–2, 1–2 drops in affected eye(s) q2h while awake (max: 8
times/d), days 3–7, 1–2 drops in affected eye(s) q4h while awake (max: 4 times/d)

Administration
Oral
 Do not give oral drug within 2 h of drugs containing aluminum or magnesium
(antacids), iron, zinc, or sucralfate.

Intravenous

PREPARE: Intermittent: Withdraw the desired dose from 500 mg (25 mg/mL) single-
use vial. Add to enough D5W, NS, D5/NS, D5/RL, or other compatible solutions to
produce a concentration of 5 mg/mL [e.g., 500 mg (or 20 mL) added to 80 mL]. Discard
any unused drug remaining in the vial.  
ADMINISTER: Intermittent: Give over 60 min. Do NOT give a bolus dose or infuse
too rapidly.  

INCOMPATIBILITIES Y-site: Do not add any drugs to levofloxacin solution or infuse

simultaneously through the same line (manufacturer recommendation).
 Store tablets in a tightly closed container. IV solution is stable for 72 h at 25° C
(77° F).

Adverse Effects ( 1%)

CNS: Headache, insomnia, dizziness. GI: Nausea, diarrhea, constipation, vomiting,
abdominal pain, dyspepsia. Skin: Rash, pruritus. Special Senses: Decreased vision,
foreign body sensation, transient ocular burning, ocular pain, photophobia. Urogenital:
Vaginitis. Body as a Whole: Injection site pain or inflammation, chest or back pain, fever,
pharyngitis.

Diagnostic Test Interference

May cause false positive on opiate screening tests.

Interactions
Drug: Magnesium or aluminum-containing antacids, sucralfate, iron, zinc may
decrease levofloxacin absorption; nsaids may increase risk of CNS reactions, including
seizures; may cause hyper- or hypoglycemia in patients on oral hypoglycemic agents.

Pharmacokinetics
Absorption: Rapidly absorbed from GI tract. Peak: PO 1–2 h. Distribution: Penetrates
lung tissue, 24%–38% protein bound. Metabolism: Minimally metabolized in the liver.
Elimination: Primarily excreted unchanged in urine. Half-Life: 6–8 h.

NURSING IMPLICATIONS
Assessment & Drug Effects

 Lab tests: Do C&S test prior to beginning therapy and periodically.

 Withhold therapy and report to physician immediately any of the following: Skin
rash or other signs of a hypersensitivity reaction (see Appendix F); CNS
symptoms such as seizures, restlessness, confusion, hallucinations, depression;
 skin eruption following sun exposure; symptoms of colitis such as persistent
diarrhea; joint pain, inflammation, or rupture of a tendon; hypoglycemic reaction
in diabetic on an oral hypoglycemic agent.

Patient & Family Education

 Learn important indications for discontinuing drug and immediately notifying

physician.
 Consume fluids liberally while taking levofloxacin.
 Allow a minimum of 2 h between drug dosage and taking any of the following:
Aluminum or magnesium antacids, iron supplements, multivitamins with zinc, or
sucralfate.
 Avoid exposure to excess sunlight or artificial UV light.
 Avoid NSAIDs while taking levofloxacin, if possible.
 Do not breast feed while taking this drug.

Common adverse effects in italic, life-threatening effects underlined: generic names in

bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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