Levofloxacin (Intravenous)

Overview

Levofloxacin, which is often sold under the trade name Levaquin, is an antibiotic. It can be used to treat various bacterial infections including pneumonia, sinusitis, chronic prostatitis, urinary tract infections and certain types of gastroenteritis.

It can also be used as a first-line treatment, in conjunction with other antibiotics, to treat serious infections such as pelvic inflammatory disease, tuberculosis and meningitis. In instances of serious infection requiring clinical treatment, Levofloxacin is typically administered intravenously.

Levofloxacin was first approved for medical use in the US in 1996. It is regarded by the World Heath Organization as an essential medicine on account of its efficacy and low wholesale cost.

This medicine is classed as a fluoroquinolone. It exhibits enhanced effectiveness against the respiratory pathogen Streptococcus pneumoniae in comparison to earlier fluoroquinolone derivatives such as ciprofloxacin. Because of this, it is regarded as a 'œrespiratory fluoroquinolone'along with other relatively new antibiotics like Gemifloxacin and moxifloxacin. It is less active than some antibiotics in tackling Gram-negative bacteria and is not a suitable treatment for infections such as MRSA.

It functions by inhibiting the topoisomerase IV and DNA gyrase of bacteria. Topoisomerase IV is required for DNA to separate and replicate, and DNA gyrase is needed for DNA to supercoil, allowing it to fit in newly-formed cells. By preventing both of these processes, Levofloxacin kills the bacteria.

Levofloxacin is one of the most widely-prescribed antibiotics in the United States, making up 28% of fluoroquinolone prescriptions in the United States every year.

Type Of Medicine

  • Antibiotic

Conditions Treated

  • Acute bacterial sinusitis
  • Pneumonia
  • Urinary tract infection
  • Chronic prostatitis
  • Gastroenteritis
  • Tuberculosis
  • Pelvic inflammatory disease
  • Meningitis
  • Respiratory tract infection
  • Cellulitis
  • Anthrax
  • Endocarditis
  • Traveler's diarrhea
  • Plague

Side Effects

Like most medications, Levofloxacin can cause some unwanted side effects along with its desired effects. The most commonly-reported side effects by patients undergoing treatment with this medicine include the following:

  • Diarrhea
  • Agitation
  • Stomach cramps or abdominal pain
  • Confusion
  • Blisters
  • Severe diarrhea, which can be watery and/or bloody
  • Fever
  • Inflammation
  • Swelling in the calves, hands and/or shoulders
  • Swelling and redness of the skin
  • Severe mental changes or changes in mood
  • Trembling
  • Unusual behaviour
  • Bleeding, discoloration of the skin, infection, inflammation, pain, redness, lumps, soreness, redness, swelling, tenderness or warmth at the site of injection

As the patient continues treatment with Levofloxacin as prescribed by a qualified doctor, most (if not all) of the previously mentioned side effects should lessen. If any side effects continue for a prolonged period or appear to get worse, the patient should inform their doctor or healthcare provider as soon as is practical. In many instances, a doctor or pharmacist may be able to recommend over the counter treatments or prescribed drugs to help alleviate some of these side effects.

Typically, most patients will only experience minor side effects while undergoing treatment with Levofloxacin, if they observe any whatsoever. The drug is intended to fight off serious bacterial infection. As such, the benefits of using Levofloxacin far outweigh the risks of experiencing mild discomfort caused by certain side effects.

Other side effects which are experienced rarely (albeit often enough to warrant mentioning) include the following:

  • Tarry, black stools
  • Tingling, numbness, burning or painful sensations
  • Changes in vision
  • Coughing
  • Dark colored urine
  • Difficulty breathing
  • Difficulty talking, chewing or swallowing
  • Irregular or fast heartbeat
  • General swelling of the body
  • Hives
  • Muscular or joint pain
  • Hoarseness
  • Muscle spasms, cramps, stiffness or pain
  • Loosening or peeling of the skin
  • Seizures
  • Swelling of the eyelids, lips, tongue or face
  • Severe dizziness
  • Severe tiredness
  • Unsteadiness or awkwardness
  • Unusual bruising or bleeding
  • Unusual weakness
  • Changes in the voice
  • Headache
  • Changes in taste
  • Drowsiness
  • Light-headedness
  • Nervousness
  • Nausea
  • Difficulty sleeping
  • Vaginal discharge and itching
  • Vomiting
  • Feeling of faintness
  • Sweating

It is worth noting that Levofloxacin use can affect the psychology of the patient. He or she can potentially experience extreme, frequent changes in mood, along with confusion, memory problems and hallucinations. Caution should therefore be taken when this drug is administered to patients with a history of mental health conditions such as schizophrenia, bipolar disorder or depression. Some patients may also experience hypersensitive reactions (rash, itching and swelling). Medical attention should be sought immediately in these circumstances.

Patients are advised to refrain from driving or operating heavy machinery while undergoing treatment with Levofloxacin. This is because this medicine can cause dizziness and co-ordination problems which could potentially put the patient or other road users at risk of an accident.

Not all side effects may have been reported. Patients who think they may have experienced a side effect which is not listed on the literature provided with this medication should consult their doctor and report their findings to the FDA.

Dosage

As with all medicines, it is imperative that the patient is administered intravenous Levofloxacin only as prescribed by a qualified physician. This means that patients must not receive any more of the drug than advised, either in terms of frequency or dose size. In addition to this, the patient should be willing to stop Levofloxacin treatment on the professional opinion of a doctor, even if there is a supply of the drug remaining.

Although it can be taken orally, Levofloxacin is administered intravenously in a clinical setting when used to treat serious infection. The dosage will vary dependent on the needs of the patient. When determining the optimum dosage, a physician will take a number of different factors into consideration. The strength of the medicine, time between doses, number of doses per day and the length of time the patient is set to receive treatment will all be taken into consideration. The age, weight, height and condition of the patient will also inform the doctor's dosing decision.

Adults dose recommendations per condition:

  • Noscocomial pneumonia: 750mg intravenously, every 24 hours for 7 to 14 days, depending on severity of infection.
  • Pneumonia (standard): 500mg intravenously, every 24 hours for a 7 to 14-day period. Alternatively, the patient may receive a stronger 750mg dose over a five-day period.
  • Uncomplicated skin and structure infection: 500mg intravenously, every 24 hours for a 7 to 10-day period.
  • Complicated skin and structure infection: 750mg intravenously, every 24 hours for a 7 to 14-day period.
  • Prostatitis: 500mg intravenously, every 24 hours for one month.
  • Bacillus anthracis (anthrax): 500mg intravenously, every 24 hours for two months. The same dosage can be used as a preventative measure against anthrax infection if the patient has been exposed to anthrax but does not show any symptoms.
  • Plague: 500mg intravenously, every 24 hours for 10 to 14 days.
  • Urinary tract infection: 250mg intravenously, every 24 hours for 10 days. Alternatively, the patient may receive a stronger 750mg dose every 24 hours over 5 days. For uncomplicated or mild UTI, the patient may receive 250mg every 24 hours for just three days.
  • Pyelonephritis: 250mg intravenously for 10 days. If the case is concurrent with bacteremia, the patient may receive 750mg every 24 hours for 5 days instead.
  • Cystitis: 250mg intravenously, every 24 hours for 3 days.
  • Bronchitis: 500mg intravenously, every 24 hours for 7 days.
  • Sinusitis: 500mg intravenously, every 24 hours for 10 to 14 days. Alternatively, the patient may receive 750mg intravenously every 24 hours for 5 days.
  • Tuberculosis (active): 500mg to 1000mg intravenously, every day. In most cases, Levofloxacin will be used as a second-line treatment for TB in conjunction with another drug.
  • Nongonococcal urethritis: 500mg every 24 hours for a 7-day period.
  • Chlamydia: 500mg every 24 hours for a 7-day period.
  • Pelvic inflammatory disease: 500mg every 24 hours for 14 days.
  • Sexually transmitted Epididymitis: 500mg every 24 hours for 10 days.

Pediatric dose recommendations per condition

  • Bacillus anthracis (anthrax): If the patient is six months or older, they should receive 8mg per kg, intravenously, every 12 hours, to a maximum of 250mg per dose, for a 60-day period.
  • Plague: If the patient is aged six months or older, they should receive 8mg per kg, intravenously, every 12 hours. The maximum dose should not exceed 250mg. Therapy with Levofloxacin for Plague should last 10 to 14 days.

While the manufacturer of Levofloxacin provides general dosage instructions, it should be reiterated that these are merely guidelines which can be altered by the prescribing doctor.

Patients are warned against receiving double doses. If a patient misses a dose, they are advised to take the missed dose as soon as possible, unless it is closer to the time for the next scheduled dose. In this case, the patient should omit the missed dose and receive the next planned intravenous dose as scheduled. However, as intravenous Levofloxacin is typically administered in a clinical setting, dose scheduling should be taken care of by the patient's healthcare team. This means that the chances of missing a dose are greatly reduced.

If the patient exhibits symptoms of an overdose (extremely fast heartbeat, difficulty breathing, loss of consciousness, seizures) outside of a clinical setting, they may require immediate medical attention. Under these circumstances, the patient or their caregiver should immediately contact their local poison control center (1800-222-1222) or emergency services (911).

Interactions

All drugs have the potential to interact with other medications or chemicals within the human body. These interactions can change the effects of the medications involved. In some instances, this can lead to a medication becoming ineffective in treating the condition it was prescribed to combat. In some cases, interactions can cause dangerous and even fatal side effects to occur. Because of these risks, it is incredibly important for the patient to keep a detailed list of all medicines they are currently taking, including the dose size and frequency of use. This applies to over the counter remedies, complementary medicines, vitamins and herbal supplements as well as prescribed drugs.

Below is a partial list of drugs known to interact negatively with Levofloxacin. Patients who are currently undergoing treatment with any of these medications should inform their doctor or healthcare provider prior to receiving their first dose of Levofloxacin:

  • Ziprasidone
  • Zinc Sulfate
  • Zinc Gluconate
  • Zinc Acetate
  • Warfarin
  • Voriconazole
  • Vinorelbine
  • Vincristine Liposome
  • Vincristine
  • Vinblastine
  • Verteporfin
  • Venlafaxine
  • Vemurafenib
  • Vasopressin
  • Vardenafil
  • Vandetanib
  • Valdecoxib
  • Valbenazine
  • Uracil Mustard
  • Umeclidinium/Vilanterol
  • Typhoid Vaccine, Live
  • Troglitazone
  • Triptorelin
  • Trimipramine
  • Triflupromazine
  • Trifluoperazine
  • Triamcinolone
  • Thalidomide
  • Tetrabenazine
  • Teriflunomide
  • Terfenadine
  • Terbutaline
  • Teniposide
  • Temozolomide
  • Telithromycin
  • Telavancin
  • Tamoxifen
  • Tacrolimus
  • Sunitinib
  • Sulindac
  • Sulfamethoxazole/Trimethoprim
  • Sulfamethoxazole
  • Sucralfate
  • Streptozocin
  • Sotalol
  • Sorafenib
  • Solifenacin
  • Salsalate
  • Salmeterol
  • Rosiglitazone
  • Romidepsin
  • Rofecoxib
  • Ritodrine
  • Risperidone
  • Rilpivirine
  • Ribociclib
  • Repaglinide
  • Ranolazine
  • Prednisolone
  • Pramlintide
  • Potassium Citrate/Sodium Citrate
  • Potassium Citrate
  • Potassium Bitartrate/Sodium Bicarbonate
  • Potassium Bicarbonate/Sodium Bicarbonate
  • Potassium Bicarbonate/Potassium Citrate
  • Potassium Acetate/Potassium Bicarbonate/Potassium Citrate
  • Posaconazole
  • Panobinostat
  • Methenamine/Sodium Biphosphate
  • Methadone
  • Metformin/Sitagliptin
  • Metformin/Saxagliptin
  • Metformin/Rosiglitazone
  • Metformin/Repaglinide
  • Metformin/Pioglitazone
  • Metformin
  • Metaproterenol
  • Mestranol/Norethindrone
  • Mesoridazine
  • Mercaptopurine
  • Meperidine/Promethazine
  • Melphalan
  • Meloxicam
  • Mefloquine
  • Mefenamic Acid
  • Meclofenamate
  • Mechlorethamine
  • Maprotiline
  • Magnesium Sulfate/Potassium Sulfate/Sodium Sulfate
  • Magnesium Aspartate
  • Magnesium Amino Acids Chelate
  • Magaldrate/Simethicone
  • Magaldrate
  • Lopinavir/Ritonavir
  • Loperamide/Simethicone
  • Lactulose
  • Ketorolac
  • Ketoprofen
  • Ketoconazole
  • Kaolin/Pectin
  • Kaolin
  • Ivabradine
  • Isoproterenol/Phenylephrine
  • Isoproterenol
  • Isoetharine
  • Iron Protein Succinylate
  • Iron Polysaccharide
  • Irinotecan
  • Iopamidol
  • Iohexol
  • Interferon Beta-1B
  • Interferon Beta-1A
  • Insulin Zinc Extended
  • Insulin Zinc
  • Insulin Regular
  • Insulin Aspart
  • Insulin
  • Inotuzumab Ozogamicin
  • Indomethacin
  • Indium Oxyquinoline In-111
  • Indacaterol
  • Imipramine
  • Iloperidone
  • Ifosfamide/Mesna
  • Ifosfamide
  • Idelalisib
  • Glyburide/Metformin
  • Formoterol/Mometasone
  • Formoterol/Glycopyrrolate
  • Formoterol
  • Daunorubicin Liposomal
  • Daunorubicin
  • Dasatinib
  • Dapagliflozin/Saxagliptin
  • Dapagliflozin/Metformin
  • Dapagliflozin
  • Dactinomycin
  • Dacarbazine
  • Cytarabine Liposomal/Daunorubicin Liposomal
  • Cytarabine
  • Cyclophosphamide
  • Cyanocobalamin/Folic Acid/Pyridoxine/Strontium Gluconate
  • Crizotinib
  • Cortisone
  • Copper Gluconate
  • Colchicine/Probenecid
  • Codeine/Promethazine
  • Codeine/Phenylephrine/Promethazine
  • Codeine/Pheniramine/Phenylephrine/Sodium Citrate
  • Clozapine
  • Clomipramine
  • Clofazimine
  • Clofarabine
  • Clarithromycin
  • Citric Acid/Sodium Citrate
  • Citric Acid/Simethicone/Sodium Bicarbonate
  • Citric Acid/Potassium Citrate/Sodium Citrate
  • Citric Acid/Potassium Citrate
  • Citric Acid/Potassium Bicarbonate/Sodium Bicarbonate
  • Citric Acid/Potassium Bicarbonate
  • Citric Acid/Magnesium Oxide/Sodium Picosulfate
  • Citric Acid/Glucono-Delta-Lactone/Magnesium Carbonate Topical
  • Citalopram
  • Cisplatin
  • Cisapride
  • Chromium Picolinate/Inulin
  • Chromium Picolinate
  • Chromic Chloride Hexahydrate/Copper Sulfate/Manganese Sulfate/Selenium/Zinc Sulfate
  • Choline Salicylate/Magnesium Salicylate
  • Choline Salicylate
  • Cholera Vaccine, Live
  • Cholecalciferol/Iron Polysaccharide
  • Cholecalciferol/Genistein/Zinc Glycinate
  • Cholecalciferol/Genistein/Zinc Chelazome
  • Chlorpropamide
  • Chlorpromazine
  • Chlorpheniramine/Ibuprofen/Pseudoephedrine
  • Chloroquine
  • Chlorambucil
  • Ceritinib
  • Celecoxib
  • Castor Oil
  • Cascara Sagrada/Phenolphthalein
  • Cascara Sagrada/Magnesium Hydroxide
  • Cascara Sagrada
  • Casanthranol/Docusate
  • Casanthranol
  • Carmustine
  • Carboplatin
  • Carbonyl Iron
  • Capecitabine
  • Canagliflozin/Metformin
  • Canagliflozin
  • Calcium/Vitamin D
  • Calcium/Folic Acid/Ginger/Pyridoxine
  • Calcium/Ferrous Fumarate/Vitamin D
  • Bisacodyl/Polyethylene Glycol 3350/Potassium Chloride/Sodium Bicarbonate/Sodium Chloride
  • Bisacodyl/Magnesium Citrate
  • Bisacodyl
  • Bioflavonoids/Zinc Glycinate
  • Bilberry/Evening Primrose/Flax
  • Bicalutamide
  • Betamethasone
  • Bepridil
  • Benzoic Acid/Methenamine/Sodium Salicylate
  • Benzoic Acid/Hyoscyamine/Methenamine/Methylene Blue/Phenyl Salicylate
  • Bedaquiline
  • Bcg
  • Balsalazide
  • Baclofen/Flurbiprofen/Lidocaine Topical
  • Azithromycin/Trovafloxacin
  • Azithromycin
  • Attapulgite
  • Atomoxetine
  • Astemizole
  • Aspirin/Pseudoephedrine
  • Aspirin/Pravastatin
  • Aspirin/Phenyltoloxamine
  • Aspirin/Pentazocine
  • Aspirin/Oxycodone
  • Aspirin/Omeprazole
  • Aspirin/Methocarbamol
  • Aspirin/Meprobamate
  • Aspirin/Hydrocodone
  • Aspirin/Dipyridamole
  • Aspirin/Diphenhydramine/Phenylpropanolamine
  • Aspirin/Diphenhydramine
  • Aspirin/Codeine
  • Aspirin/Citric Acid/Sodium Bicarbonate
  • Aspirin/Chlorpheniramine/Phenylpropanolamine
  • Aspirin/Chlorpheniramine/Phenylephrine
  • Aspirin/Chlorpheniramine/Dextromethorphan/Phenylpropanolamine
  • Aspirin/Chlorpheniramine/Dextromethorphan
  • Aspirin/Carisoprodol/Codeine
  • Aspirin/Carisoprodol
  • Aspirin/Calcium Carbonate
  • Aspirin/Caffeine/Salicylamide
  • Aspirin/Caffeine/Propoxyphene
  • Aspirin/Caffeine/Orphenadrine
  • Aspirin/Caffeine/Dihydrocodeine
  • Aspirin/Caffeine
  • Aspirin/Butalbital/Caffeine/Codeine
  • Aspirin/Butalbital/Caffeine
  • Aspirin/Butalbital
  • Aspirin/Brompheniramine/Dextromethorphan/Phenylpropanolamine
  • Aspirin
  • Asenapine
  • Ascorbic Acid/Iron Polysaccharide
  • Ascorbic Acid/Ferrous Sulfate
  • Ascorbic Acid/Ferrous Fumarate
  • Ascorbic Acid/Carbonyl Iron
  • Artemether/Lumefantrine
  • Arsenic Trioxide
  • Aripiprazole
  • Arformoterol
  • Apomorphine
  • Anisindione
  • Anhydrous Calcium Iodide/Isoproterenol
  • Anhydrous Calcium Iodide/Codeine
  • Anagrelide
  • Ampicillin/Probenecid
  • Amoxicillin/Clarithromycin/Omeprazole
  • Amoxicillin/Clarithromycin/Lansoprazole
  • Amoxapine
  • Amitriptyline/Perphenazine
  • Amitriptyline/Chlordiazepoxide
  • Amitriptyline
  • Amiodarone
  • Aminolevulinic Acid Topical
  • Aluminum Hydroxide/Mineral Oil
  • Aluminum Hydroxide/Magnesium Trisilicate
  • Aluminum Hydroxide/Magnesium Hydroxide/Simethicone
  • Aluminum Hydroxide/Magnesium Hydroxide
  • Aluminum Hydroxide/Magnesium Carbonate
  • Aluminum Hydroxide/Diphenhydramine/Lidocaine/Magnesium Hydroxide/Simethicone Topical
  • Aluminum Hydroxide/Calcium Carbonate/Magnesium Hydroxide/Simethicone
  • Aluminum Hydroxide/Aspirin/Calcium Carbonate/Magnesium Hydroxide
  • Aluminum Hydroxide
  • Aluminum Carbonate
  • Altretamine
  • Alogliptin/Pioglitazone
  • Alogliptin/Metformin
  • Acarbose
  • Abiraterone
  • Abarelix

Warnings

Levofloxacin may cause tearing or swelling of the tendons ' especially in the Achilles tendon. This can happen during treatment with Levofloxacin or months after the patient has stopped taking Levofloxacin. This is much more common in patients who:

  • Are over the age of 60
  • Are taking steroid medication
  • Have had a kidney, lung or heart transplant

Patients who are allergic to fluoroquinolones should not take this medication, as it may cause severe hypersensitive reactions. This medication may also be unsuitable for patients who use a blood thinner (such as warfarin, Jantoven or Coumadin) or patients with certain conditions, including:

  • Tendon problems
  • Bone problems
  • Arthritis
  • Joint problems
  • Slow heartbeat or other heart rhythm disorder
  • Long QT syndrome
  • Kidney disease
  • Liver disease
  • Epilepsy or other seizure disorder
  • Nerve disorder
  • Low potassium levels in the blood (hypokalemia)

This medicine should not be administered to a child without proper medical advice from a qualified doctor. This is because joint and tendon problems are more likely to occur in children taking Levofloxacin.

The course of treatment with Levofloxacin should be followed through completely. In most cases, symptoms of infection will lessen to the point of becoming unnoticeable before the infection has fully cleared. Skipping a dose provides the infection with an opportunity to come back and can even increase the risk of the patient contracting further infections which are resistant to antibiotics.

Like all antibiotics, Levofloxacin is not suitable for the treatment of viral infections, such as the common cold or flu. It is only suitable for treating bacterial infection.

This medication could cause patients to achieve a false-positive on a drug screening test. If the patient is required to provide a urine sample for drug testing, they should inform the laboratory staff that they are receiving treatment with Levofloxacin.

While taking Levofloxacin, patients should avoid exposure to sunlight and UV light. This is because Levofloxacin causes changes in the body which make the patient more susceptible to sunburn. Patients are therefore advised to avoid the use of tanning beds for the duration of treatment with this medication, and to wear protective clothing and use sunscreen of at least SPF 30 when outdoors. Patients who experience severe redness, burning, itching or swelling after exposure to sunlight should consult their doctor immediately.

Antibiotic medicines such as Levofloxacin can cause diarrhea, which can often be a sign or symptom of a new infection. Patients who experience watery or bloody diarrhea should consult their doctor as soon as possible.

Storage

Levofloxacin should be stored at room temperature and kept away from sources of moisture and heat. Because this medicine is prepared for intravenous use in a clinical setting, it should be the responsibility of the patient's healthcare provider to ensure that it is stored in a safe manner, in accordance with FDA guidelines.

When treatment is completed in a clinical setting, the patient's healthcare provider is responsible for disposing of any opened but unused medication, along with any IV tubing and paraphernalia.

Summary

Levofloxacin is a hugely beneficial medication, but it can also pose a risk to patients who do not communicate fully with their healthcare providers. As a treatment designed to alleviate symptoms of severe bacterial infection, Levofloxacin reduces symptoms such as fever, pain, swelling, nausea, vomiting, diarrhea, muscle aches and more - but it can also affect co-ordination and cause unpleasant side effects. By producing feelings of dizziness and drowsiness, this drug could impair the day-to-day functioning of the patient and potentially create perilous situations if the correct precautions are not taken.

Because of these risks, it is important for the patient to inform their doctor of as much of their medical history as possible, including any relevant hereditary illnesses (diseases which run in the family). Hundreds of medications can cause adverse reactions when taken at the same time as Levofloxacin, and there are several medical conditions which can be exacerbated by the drug. This makes it important for the patient to be honest with their doctor.

When taken correctly, Levofloxacin provides relief from symptoms of severe infection which, if left untreated, could cause severe long-term problems or even death. This medicine helps the patient to recover fully from infections such as tuberculosis and pneumonia, providing them with a better quality of life, free from infection. To achieve this, both patient and doctor must work together to ascertain the most appropriate dosage and optimum frequency of use.