Antimicrobials
Levofloxacin

Levofloxacin

High
Excellent

Dosing

General Information

Administration

  • 250-500mg solutions infused over 60 minutes

  • 750mg solution infused over 90 minutes

  • Too rapid of infusions can cause hypotension

  • Do not administer through the same line as solutions containing multivalent cations (i.e. Mg++, Ca++)

  • Maintain adequate hydration to prevent crystalluria or cylindruria

  • PO dose: administer with or without food, 2 hours before or after antacids or multivitamins containing zinc

Preparation

  • Single-use vials must be diluted in D5W or NS to final concentration 5mg/mL

Compatibility

  • D5W or NS. Not tested in LR
  • Lower respiratory infection (CAP, HAP)

  • Intra-abdominal infection

  • Complicated or uncomplicated UTI and pyelonephritis

  • SSTI

  • Anthrax post-exposure

Tier 3 Protected Antimicrobial

  • Limited to use for the listed indications. For all other indications, the antimicrobial must be ordered by an ID physician or an ID consult placed. Prospective audit with feedback with provided by ASP/Pharmacy and utilization/compliance reported quarterly.

AHS Use Criteria:

  • Traveler’s diarrhea

  • Typhoid/paratyphoid if allergic to ceftriaxone

  • Community acquired pneumonia if allergic to ceftriaxone AND azithromycin AND doxycycline

  • Serious Legionella infection, allergic to azithromycin AND doxycycline

  • Transition to PO in a susceptible gram-negative infection

  • Allergy to all alternatives, last line option

  • Monitor QTc in patients with increased risk

  • Renal, hepatic and hematopoietic function periodically

  • Crystalluria

  • Signs of infection

  • Signs/symptoms of tendinopathy or peripheral neuropathy

  • Disordered glucose regulation

  • Hypersensitivity

  • QTc prolongation

  • Dysglycemia

  • Rash

  • Tendinopathy and rupture

  • GI upset

  • Weakness exacerbation in myasthenia gravis

  • CNS toxicity including confusion, psychosis

  • Other QTc prolonging agents

  • Divalent cations - Decreased absorption

  • NSAIDs - Increase seizure risk

  • Warfarin - Increased INR

Antimicrobial class: Fluoroquinolone

Pregnancy category: C

Average serum half life: 7 hours

Biliary penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Therapeutic

CSF penetration: Poor, ~15% of serum concentration

Bone penetration: Therapeutic, can delay bone development

Levaquin