LEVOFLOXACIN

LEVOFLOXACIN
(lev-o-flox'a-sin)
Levaquin, Iquix, Quixin
Classifications: antibiotic; quinolone;
Therapeutic: antibiotic

Prototype: Ciprofloxacin
Pregnancy Category: C

Availability

250 mg, 500 mg, 750 mg tablets; 25 mg/mL solution; 25 mg/mL injection; 0.5%, 1.5% ophthalmic solution

Action

A broad-spectrum fluoroquinolone antibiotic that inhibits topoisomerase IV and DNA-gyrase, an enzyme necessary for bacterial replication, transcription, repair, and recombination.

Therapeutic Effect

Effective against many aerobic gram-positive and aerobic gram-negative organisms.

Uses

Treatment of maxillary sinusitis, acute exacerbations of bacterial bronchitis, community-acquired pneumonia, uncomplicated skin/skin structure infections, UTI, acute pyelonephritis caused by susceptible bacteria; acute bacterial sinusitis; chronic bacterial prostatitis; bacterial conjunctivitis.

Contraindications

Hypersensitivity to levofloxacin and quinolone antibiotics; tendon pain, inflammation or rupture; syphilis; viral infections; phototoxicity; suicidal ideation; psychotic manifestations; manifestations of peripheral neuropathy; hypoglycemic reaction to drug; QT prolongation, hypokalemia; concurrent administration of class IA (e.g., quinidine, procainamide) or class III (e.g., amiodarone, sotalol) antiarrhythmic agents; pregnancy (category C); lactation. Safety and efficacy in children <18 y are not established.

Cautious Use

History of suicidal ideation; psychosis; anxiety, confusion, depression; known or suspected CNS disorders predisposed to seizure activity (e.g., severe cerebral atherosclerosis), risk factors associated with potential seizures (e.g., some drug therapy, renal insufficiency), dehydration, renal impairment (Clcr <50 mL/min); colitis; cardiac arrhythmias; diabetes; patients receiving theophylline or caffeine; older adults.

Route & Dosage

Infections
Adult: PO 500 mg q24h x 10 d IV 500 mg infused over 60 min q24h x 7–14 d

Community-Acquired Pneumonia
Adult: PO/IV 750 mg q24h x 5 d

Uncomplicated UTI
Adult: PO/IV 250 mg q24h x 14 d

Complicated UTI, Pyelonephritis
Adult: PO/IV 250 mg q24h x 10 d

Acute Bacterial Sinusitis
Adult: PO/IV 750 mg q.d. x 5 d

Chronic Bacterial Prostatitis
Adult: PO/IV 500 mg q24h x 28 d

Skin & Skin Structure Infections
Adult: PO 750 mg q24h x 14 d

Renal Impairment
For initial dose of 500 mg, adjust as follows: Clcr 20–50 mL/min: 250 mg q24h; <20 mL/min: 250 mg q48h
For initial dose of 750 mg, adjust as follows: Clcr 20–50 mL/min: 750 mg q48h; 10–19 mL/min: 500 mg q48h; <20 mL/min: 250 mg q48h

Bacterial Conjunctivitis
Adult: Ophthalmic Days 1–2, 1–2 drops in affected eye(s) q2h while awake (max: 8 times/d), days 3–7, 1–2 drops in affected eye(s) q4h while awake (max: 4 times/d)

Administration

Oral
  • Do not give oral drug within 2 h of drugs containing aluminum or magnesium (antacids), iron, zinc, or sucralfate.
Intravenous

PREPARE: Intermittent: Withdraw the desired dose from 500 or 750 mg (25 mg/mL) single-use vial. Add to enough D5W, NS, D5/NS, D5/RL, or other compatible solutions to produce a concentration of 5 mg/mL [e.g., 500 mg (or 20 mL) added to 80 mL]. Discard any unused drug remaining in the vial.  

ADMINISTER: Intermittent: Infuse 500 mg or less over 60 min. Infuse 750 mg over at least 90 min. Do NOT give a bolus dose or infuse too rapidly.  

INCOMPATIBILITIES Y-site: Do not add any drugs to levofloxacin solution or infuse simultaneously through the same line (manufacturer recommendation). Azithromycin, furosemide, heparin, indomethacin, insulin, nitroglycerin, nitroprusside, propofol.

  • Store tablets in a tightly closed container. IV solution is stable for 72 h at 25° C (77° F).

Adverse Effects (≥1%)

CNS: Headache, insomnia, dizziness. GI: Nausea, diarrhea, constipation, vomiting, abdominal pain, dyspepsia. Skin: Rash, pruritus. Special Senses: Decreased vision, foreign body sensation, transient ocular burning, ocular pain, photophobia. Urogenital: Vaginitis. Body as a Whole: Injection site pain or inflammation, chest or back pain, fever, pharyngitis. Other: Cartilage erosion.

Diagnostic Test Interference

May cause false positive on opiate screening tests.

Interactions

Drug: Magnesium or aluminum-containing antacids, sucralfate, iron, zinc may decrease levofloxacin absorption; nsaids may increase risk of CNS reactions, including seizures; may cause hyper- or hypoglycemia in patients on oral hypoglycemic agents.

Pharmacokinetics

Absorption: Rapidly from GI tract. Peak: PO 1–2 h. Distribution: Penetrates lung tissue, 24–38% protein bound. Metabolism: Minimally in the liver. Elimination: Primarily unchanged in urine. Half-Life: 6–8 h.

Nursing Implications

Assessment & Drug Effects

  • Lab tests: Do C&S test prior to beginning therapy and periodically.
  • Withhold therapy and report to physician immediately any of the following: Skin rash or other signs of a hypersensitivity reaction (see Appendix F); CNS symptoms such as seizures, restlessness, confusion, hallucinations, depression; skin eruption following sun exposure; symptoms of colitis such as persistent diarrhea; joint pain, inflammation, or rupture of a tendon; hypoglycemic reaction in diabetic on an oral hypoglycemic agent.

Patient & Family Education

  • Learn important indications for discontinuing drug and immediately notifying physician.
  • If tendon pain occurs, discontinue the drug and notify the physician.
  • Consume fluids liberally while taking levofloxacin.
  • Allow a minimum of 2 h between drug dosage and taking any of the following: Aluminum or magnesium antacids, iron supplements, multivitamins with zinc, or sucralfate.
  • Avoid exposure to excess sunlight or artificial UV light.
  • Avoid NSAIDs while taking levofloxacin, if possible.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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