levoFLOXacin

C difficile risk
High
Oral Bioavailability
Excellent

Dosing

Usual Dose High dose for bacteremia, complicated UTI, pyelonephritis, complicated skin infection, nosocomial pneumonia, intra-abdominal infections, infections due to Pseudomonas spp500 mg IV/PO q24h750 mg IV/PO q24h

Usual doseHigh dose for bacteremia, complicated UTI, pyelonephritis, complicated skin infection, nosocomial pneumonia, intra-abdominal infections, infections due to Pseudomonas spp- CrCl 20-49: 500mg once then 250mg IV/PO q24h

  • CrCl <20: 500mg IV/PO once then 250mg IV/PO q48h- CrCl 20-49: 750mg IV/PO q48h

  • CrCl <20: 750mg IV/PO once then 500mg IV/PO q48h

Usual doseHigh dose for bacteremia, complicated UTI, pyelonephritis, complicated skin infection, nosocomial pneumonia, intra-abdominal infections, infections due to Pseudomonas spp500mg IV/PO once then 250mg IV/PO q48h750mg IV/PO once then 500mg IV/PO q48h

General Information

Lower respiratory infection (CAP requiring ICU admission, HAP) - NOT a first-line agent, see guidelines

Monitor QTc in patients with increased risk.

  • 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

  • Warfarin - Increased INR

  • Avoid dairy products, antacids, and other sources of divalent cations (Ca, Fe, Mg, Al, Zn) which can chelate levofloxacin and prevent absorption

  • Must hold continuous tube feeding 2 h before and 2 h after administration.

  • While levofloxacin has some activity against Pseudomonas, ciprofloxacin should be preferred for definitive therapy

Antimicrobial class: Fluoroquinolone

Pregnancy category: C

Average serum half life: 7 hours

Biliary penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Therapeutic