Spectrum: Local Antimicrobial Stewardship, for Billings Clinic

Levofloxacin

C. diff Risk

High

Oral Bioavailability

Excellent

Approximate Cost

PO:<$1
IV: $2-$3

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

General Spectrum of Activity

Antibiogram Data

Dosing

Renal

Pediatric

6 m to 4 years16-20 mg/kg/day divided q12h

5 years and older8-10 mg/kg q24h

Adult

750mg PO/IV daily

Oncology prophylaxis: 500 mg PO q24h

General Information

Unacceptable Uses

Unacceptable Uses

FDA warns against use in the following scenarios: uncomplicated urinary tract infection, acute bacterial exacerbation of chronic bronchitis, and acute bacterial sinusitis.

Common Usage

Common Usage

  • Lower respiratory infection (CAP, HAP)

  • Intraabdominal infection (+metronidazole)

Drug Monitoring

Drug Monitoring

Monitor QTc in patients with increased risk

First Line Indications

First Line Indications

Legionella pneumonia

Adverse Effects

Adverse Effects

  • QTc prolongation

  • Dysglycemia

  • Rash

  • Tendinopathy and rupture

  • Peripheral neuropathy

  • GI upset

  • Weakness exacerbation in myasthenia gravis

  • CNS toxicity including confusion, insomnia, psychosis - especially in elderly patients

  • Aortic dissections or ruptures

Major Interactions

Major Interactions

  • Other QTc prolonging agents

  • Divalent cations - Decreased absorption

  • Warfarin - Increased INR

Additional Information

Additional Information

Due to reduced Pseudomonas aeruginosa susceptibility to quinolones at Billings Clinic, double covering by adding a quinolone to cefepime/piperacillin-tazobactam is not recommended.

Pharmacology

Pharmacology

Antimicrobial class: Fluoroquinolone

Pregnancy category: C

Average serum half life: 7 hours

Biliary penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Therapeutic