levofloxacin

(lee voe flox' a sin)

Levaquin

 

Pregnancy Category C

 

Drug classes

Antibiotic

Fluoroquinolone

 

Therapeutic actions

Bactericidal: Interferes with DNA by inhibiting DNA synase replication in susceptible gram-negative and gram-positive bacteria, preventing cell reproduction.

 

Indications

        Treatment of adults with community-acquired pneumonia, acute maxillary sinusitis caused by susceptible bacteria, including multidrug resistant strains

        Treatment of acute exacerbation of chronic bronchitis caused by susceptible bacteria

        Treatment of complicated and uncomplicated skin and skin structure infections caused by susceptible bacteria

        Treatment of complicated and uncomplicated UTIs and acute pyelonephritis caused by susceptible bacteria

        Treatment of chronic bacterial prostatitis due to Escherichia coli, Enterococcus faecalis, Staphylococcus

        Treatment of nosocomial pneumonia due to methicillin-sensitive Staphylococcus aureus, Pseudomonas strains, Serratia species, Escherichia coli, Klebsiella, Haemophilus influenzae, Streptococcus pneumoniae

        Unlabeled uses: Anthrax, traveler's diarrhea, epididymitis, gonococcal infection, pelvic inflammatory disease, urethritis

 

Contraindications and cautions

        Contraindicated with allergy to fluoroquinolones, lactation.

        Use cautiously with renal dysfunction, seizures, pregnancy.

 

Available forms

Tablets—250, 500, 750 mg; injection—500, 750 mg; premixed injection—250, 500, 750 mg; oral solution—25 mg/mL

 

Dosages

ADULTS

        Pneumonia: 500 mg daily PO or IV for 7–14 days.

        Sinusitis: 500 mg daily PO or IV for 10–14 days.

        Chronic bronchitis: 500 mg daily PO or IV for 7 days.

        Skin infection: 500–750 mg daily PO or IV for 7–14 days.

        UTIs: 250 mg daily PO or IV for 3–10 days.

        Pyelonephritis: 250 mg daily PO or IV for 10 days.

        Nosocomial pneumonia: 750 mg daily PO or IV for 7–14 days.

        Chronic prostatitis: 50 mg/day PO for 28 days or 500 mg/day by slow IV infusion over 90 min for 28 days.

PEDIATRIC PATIENTS

Not recommended in patients < 18 yr.

PATIENTS WITH RENAL IMPAIRMENT

Creatinine Clearance (mL/min)

Dose

50–80

No adjustment

20–49

500 mg initially, then 250 mg daily

10–19

500 mg initially, then 250 mg q 48 hr

        Chronic prostatitis:

Creatinine Clearance (mL/min)

Dose

50–80

No adjustment

20–49

250 mg daily

10–19

250 mg q 48 hr

For patients on hemodialysis, use 250 mg q 48 hr.

 

Pharmacokinetics

Route

Onset

Peak

Duration

Oral

Varies

1–2 hr

3–5 hr

IV

Rapid

End of infusion

3–5 hr

 

Metabolism: Hepatic; T1/2: 4–7 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Urine

 

IV facts

Preparation: No further preparation is needed if using the premixed solution; dilute single-use vials in 50–100 mL D5W.

Infusion: Administer slowly over at least 60–90 min. Do not administer IM or subcutaneously.

Compatibilities: Can be further diluted in 0.9% sodium chloride injection, 5% dextrose injection, 5% dextrose/0.9% sodium chloride, 5% dextrose in lactated Ringer's, Plasma-Lyte 56 and 5% Dextrose injection, 9% dextrose/0.45% sodium chloride, 0.15% potassium chloride, sodium lactate injection.

 

Adverse effects

        CNS: Headache, dizziness, insomnia, fatigue, somnolence, blurred vision

        GI: Nausea, vomiting, dry mouth, diarrhea, abdominal pain (occur less with this drug than with oflaxacin), constipation, flatulence

        Hematologic: Elevated BUN, AST, ALT, serum creatinine, and alkaline phosphatase; neutropenia, anemia

        Other: Fever, rash, photosensitivity, muscle and joint tenderness, increased serum glucose

 

Interactions

        Decreased therapeutic effect with iron salts, sulcrafate, antacids, zinc, magnesium (separate by at least 2 hr)

        Increased risk of seizures with NSAIDs; avoid this combination

        Increased risk of severe photosensitivity reactions if combined with St. John's wort therapy

 

Nursing considerations

Assessment

        History: Allergy to fluoroquinolones, renal dysfunction, seizures, lactation, pregnancy

        Physical: Skin color, lesions; T; orientation, reflexes, affect; mucous membranes, bowel sounds; renal and liver function tests; blood glucose (diabetics)

 

Interventions

        Arrange for culture and sensitivity tests before beginning therapy.

        Continue therapy as indicated for condition being treated.

        Administer oral drug 1 hr before or 2 hr after meals with a glass of water; separate oral drug from other cation administration, including antacids, by at least 2 hr.

        Ensure that patient is well hydrated during course of therapy.

        WARNING: Discontinue drug at any sign of hypersensitivity (rash, photophobia) or at complaint of tendon pain, inflammation, or rupture.

        Monitor clinical response; if no improvement is seen or a relapse occurs, repeat culture and sensitivity test.

 

Teaching points

        Take oral drug on an empty stomach, 1 hr before or 2 hr after meals. If an antacid is needed, do not take it within 2 hr of levofloxacin dose.

        Drink plenty of fluids while you are using this drug.

        You may experience these side effects: Nausea, vomiting, abdominal pain (eat frequent small meals); diarrhea or constipation (consult nurse or physician); drowsiness, blurred vision, dizziness (use caution if driving or operating dangerous equipment); sensitivity to sunlight (avoid exposure, use a sunscreen if necessary).

        Report rash, visual changes, severe GI problems, weakness, tremors.

 

Adverse effects in Italic are most common; those in Bold are life-threatening.