Levofloxacin

C. diff Risk

High

Oral Bioavailability

Excellent

Approximate Cost

IV:$
PO:$

Dosing

500-750mg PO/IV daily

Levofloxacin has high oral bioavailability – consider initiating with/switching to oral therapy when patient tolerating orals

CrCl >50 mL/minCrCl 10 - 50 mL/minCrCl <10 mL/min (ESRD not on HD)Dialysis (HD)Dialysis (CRRT)250-500mg IV/PO Q24h500mg x1 then 250mg IV/PO Q24h500mg x1 then 250mg IV/PO Q48h500mg x1 then 250mg Q48h750mg x1 then 250mg-500mg Q24h

CrCl >50 mL/minCrCl 10 - 50 mL/minCrCl <10 mL/min (ESRD not on HD)Dialysis (HD)Dialysis (CRRT)750mg IV/PO Q24h750mg x1 then 750mg IV/PO Q48h750mg x1 then 500mg IV/PO Q48h500mg x1 then 250mg Q48h750mg x1 then 250mg-500mg Q24h

Creatinine Clearance >50mL/min/1.73m²Creatinine Clearance 10-29mL/min/1.73m²Creatinine Clearance ≤10mL/min/1.73m²10mg/kg/dose Q12H10mg/kg/dose Q24H10 mg/kg/dose x1 dose
then
5-7 mg/kg/dose Q48H

Creatinine Clearance >50mL/min/1.73m²Creatinine Clearance 10-50mL/min/1.73m²Creatinine Clearance ≤10mL/min/1.73m²10mg/kg/dose Q24H10mg/kg/dose Q48H10 mg/kg/dose x1 dose
then
5-7 mg/kg/dose Q48H

750mg Q24H

General Information

Adverse Effects

  • GI effects

  • Arthropathy (especially in pediatric patients)

  • Tendon rupture

  • Prolongation of QT interval

  • CNS effects

Drug Monitoring

Laboratory

  • Consider periodic Cr and LFTs with prolonged use

Clinical

  • Hypersensitivity

  • GI effects

  • Drug interactions (warfarin),

  • Prolongation of QT interval (amiodarone),

  • CNS effects,

  • Photosensitivity

Major Interactions

  • Other QTc prolonging agents

  • Divalent cations - decreased absorption

  • NSAIDs - increase seizure risk

  • Warfarin - increased INR

Pharmacology

Antimicrobial class: Fluoroquinolone

Pregnancy category: C

Average serum half life: 7 hours

Biliary penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Therapeutic

Common Usage

Lower respiratory infection (CAP, HAP), intraabdominal infection