| LEVOFLOXACIN |
Levaquin, Iquix, Quixin
Classifications: antiinfective; antibiotic; quinolone
Pregnancy Category: C
250 mg, 500 mg, 750 ciprofloxacin mg tablets; 25 mg/mL solution; 250 mg, 500 mg, 750 mg injection; 0.5% ophthalmic solution
A broad-spectrum fluoroquinolone antibiotic that inhibits DNA-gyrase, an enzyme necessary for bacterial replication, transcription, repair, and recombination.
Effective against many gram-positive and gram-negative organisms.
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.
Hypersensitivity to levofloxacin and quinolone antibiotics; hypokalemia, tendon pain, pregnancy (category C); syphilis; viral infections; phototoxicity; lactation.
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, colitis; QT prolongation, cardiac arrhythmias; renal impairment; diabetes; patients receiving theophylline or caffeine; older adults. Safety and efficacy in children <18 y are not established.
| Infections |
Adult: PO 500 mg q24h x 10 d IV 500 mg infused over 60 min q24h x 7–14 d
Complicated UTI, Pyelonephritis
Acute Bacterial Sinusitis
Chronic Bacterial Prostatitis
Skin & Skin Structure Infections
- 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 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: Give over 60 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). Amiodarone, azithromycin.
- Store tablets in a tightly closed container. IV solution is stable for 72 h at 25° C (77° F).
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.
May cause false positive on opiate screening tests.
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.
Absorption: Rapidly absorbed from GI tract. Peak: PO 1–2 h. Distribution: Penetrates lung tissue, 24–38% protein bound. Metabolism: Minimally metabolized in the liver. Elimination: Primarily excreted unchanged in urine. Half-Life: 6–8 h.
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.
- 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.
- Do not breast feed while taking this drug.
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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