Antimicrobials

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Levofloxacin

Guidelines for use

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1. Spectrum of Activity

Active against:

  • Streptococci
  • Most aerobic gram negative rods, including H. influenzae, E. coli, K. pneumoniae, P. mirabilis, Enterobacter, Serratia, Citrobacter
  • N. gonorrhoeae
  • Atypical bacteria (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophilia)

Not active against:

  • Anaerobes
  • Staphylococci (may have some activity; however, levofloxacin is not a recommended treatment)
  • Limited anti-pseudomonal activity

2. Clinical Use

Appropriate Uses:

  • Pneumonia, community or nursing-home acquired
  • Hospital acquired pneumonia (non-ventilator-associated) in patients with life-threatening penicillin allergy

Inappropriate Uses:

  • Urinary Tract Infection
  • Patients with pneumonia for whom Tuberculosis is in the differential diagnosis

3. Precautions

  • Pregnancy: Limited human data. Not expected to increase risk of major congenital malformations.
  • Breastfeeding: Limited human data; however, short-term use is acceptable during breastfeeding. Monitor nursing infant for GI symptoms.

4. Adverse Effects

  • CNS: (<5%) confusion, dizziness, headaches, tremor, restlessness, seizures (rare)
  • Dermatological: skin rash, pruritus
  • Cardiac: QTc prolongation with risk for progression to Torsades de Pointes. Caution in patients with risk factors (concurrent QT-prolonging medications, cardiac comorbidities, advanced age, etc)

5. Dosage

  • Pneumonia: 750 mg PO or IV once daily

Renal insufficiency:

CREATININE CLEARANCE (mL/min) DOSAGE
30 to 49 750 mg load; then 500 mg q24h
10 to 29 750 mg q48h
< 10 or PD 750 mg load; then 500 mg q48h
Hemodialysis (HD) 750 mg load; then 500 mg q48h (without regard to time of HD)
Continuous Renal Replacement Therapy (CRRT) 750 mg q24h

6. Administration

  • Intermittent Infusion: Infuse over 60 minutes
  • Please refer to IV drug monograph on pharmacy intranet page for additional administration information.

Last updated: June 20, 2016