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Antimicrobials
Levofloxacin

Levofloxacin

C difficile risk
High
Oral Bioavailability
Excellent
Cost
IV: $$$$ PO: $

Spectrum Of Activity

Antibiogram Data

Dosing

Infants & Children

≥6 months to <5 yrs≥5 yrs10 mg/kg/dose IV/PO q12h10 mg/kg/dose IV/PO q24hDose limit: 750 mg/dose

Outpatient beta lactam allergyLevofloxacin 500 mg PO daily x 14 days

Renal

Moderate Severe50% of dose q24h50% of dose q48h

General Information

Empiric Uses

  • Community-acquired pneumonia, or sepsis: In patients with allergies to 1st line drugs; or in patients where IV therapy for coverage for Mycoplasma is needed

  • Bacterial Meningitis:

    • Older children: Significant beta-lactam allergy: Vancomycin + Levofloxacin

  • Sickle cell disease: Significant Beta-lactam allergy: Levofloxacin

  • Sickle cell disease: Significant Beta-lactam allergy: Levofloxacin ± Vancomycin

Funding

Limited Use Product

337

  • CAP with co-morbidity: Community-acquired pneumonia with co-morbid illnesses or failure to first-line therapy

  • LU Authorization Period: 1 year

338

  • COPD with risk: Acute bacterial exacerbation of chronic obstructive pulmonary disease (COPD) with risk factors*; bronchiectasis.

    • *Risk factors include: poor pulmonary lung function (FEV1 below 50% predicted level), age over 65 years, co-morbid medical illness (congestive heart failure, diabetes, chronic renal failure, chronic liver disease), chronic corticosteroid use, malnutrition, prolonged duration of disease or 4 or more exacerbations per year

  • LU Authorization Period: 1 year

339

  • Step-Down: Step-down therapy after parenteral therapy or hospital / emergency department discharge

  • LU Authorization Period: 1 year

977

  • Exceptional cases of allergy or intolerance to all other appropriate therapies

  • LU Authorization Period: 1 year

Adverse Effects

  • QTc prolongation

  • Dysglycemia

  • CNS toxicity including confusion, psychosis

  • Tendinopathy and rupture

  • GI upset

  • Weakness exacerbation in myasthenia gravis

  • Rash

Drug Monitoring

  • Evaluation of organ system functions (renal, hepatic, and hematopoietic) is recommended periodically during therapy

  • The possibility of crystalluria should be assessed, hydration status

  • WBC and signs of infection

  • Number and type of stools/day for diarrhea

  • Signs and symptoms of tendonitis

Dietary Concerns

  • Administration with food prolonged time to peak by ~1 hour and decreased the peak concentration by ~14% and ~25% for the tablet and oral solution, respectively

  • Management: Tablet may be administered without regard to food; oral solution should be administered at least 1 hour before or 2 hours after food

Major Interactions

Check for drug interactions prior to use

Additional Information

  • Round levofloxacin doses to nearest tablet (250 mg, 500 mg) or half tablet

  • Tablets may be crushed but will have a bitter taste when crushed