Levofloxacin (Levaquin)

• Generic name: Levofloxacin
• Brand/Trade names: Levaquin
• Dosages:
  Tablets 250 mg, 500 mg, 750 mg;
  Solution, oral 25 mg/mL;
  Injection (concentrate) 500 mg (25 mg/mL), 750 mg (25 mg/mL);
  Injection (premix) 250 mg (5 mg/mL), 500 mg (5 mg/mL), 750 mg (5 mg/mL).
• Pharmacologic category: Fluoroquinilone antibiotic
• FDA approved: December 20, 1996
• Habit forming? No
• Pregnancy risk factor: C

Levofloxacin is a broad-spectrum a fluoroquinolone antibiotic marketed by Ortho-McNeil under the brand name Levaquin.

Levofloxacin indicated uses include:

• Respiratory Tract Infections: community-acquired pneumonia (CAP), nosocomial pneumonia, acute exacerbations of chronic bronchitis (AECB), acute sinusitis.
• Genitourinary Tract infections: chronic bacterial prostatitis, uncomplicated UTI, acute pyelonephritis, complicated UTI
• Complicated skin & skin structure infections
• Uncomplicated skin and skin structure infections

Nausea, anxiety, insomnia, headache, diarrhoea and vomiting are the most common side effects associated with levofloxacin 4.

• Absorption: Rapid and complete.
• Metabolism: Undergoes limited hepatic metabolism.
• Elimination half-life: 6 to 8 h
• Excretion: 87% excreted as unchanged drug in urine, less than 4% in the feces.

• broad spectrum of activity
• one of the safest new fluoroquinolones 4
• less phototoxicity potential 3
• less CNS disturbances 3
• less cardiac effects 3
• does not have any major drug-drug interactions (with warfarin, theophylline, or cyclosporin), compared to some of the other fluoroquinolones
• rapidly absorbed and extensively distributed into the tissues, the concentrations of the drug are typically found to be higher in the tissues or body fluids than in plasma
• increased drug concentration - higher concentrations of levofloxacin also may help prevent the emergence of resistant organisms, a serious problem associated with fluoroquinolone use
• two mechanisms of action for bactericidal activity, one requiring RNA and protein synthesis, and another which does not
• excellent bioavailability both orally and intravenously
• highly active against Klebsiella species
• active against the organisms causing atypical pneumonias
• may be useful in persons with liver disease in whom other fluoroquinolones may be contraindicated
• enhanced activity against gram-positive bacteria (including Streptococcus pneumoniae) compared with the older fluoroquinolones
• once-daily dose regimen

• tendon rupture, tendonitis and arthropathies (can occur during or after the thertment with levofloxacin)
• peripheral neuropathy (nerve damage)
• expensive

• Disseminated gonococcal infections
• Pelvic inflammatory disease
• Typhoid fever 2
• Gynecological infections 5
• Legionnaires disease 6
• Community-acquired pneumonia in children 7

Levofloxacin is the L-isomer of the racemate, ofloxacin, a quinolone antibiotic. The antibacterial activity of ofloxacin resides primarily in the L-isomer. The mechanism of action of levofloxacin and other fluoroquinolone antimicrobials involves the inhibition of bacterial topoisomerase IV and DNA gyrase (both of which are Type II topoisomerases), enzymes required for DNA replication, transcription, repair, and recombination.

As the S (-) enantiomer of the fluoroquinolone, ofloxacin, levofloxacin, inhibits DNA-gyrase in susceptible organisms thereby inhibits relaxation of supercoiled DNA and promotes breakage of DNA strands. DNA gyrase (topoisomerase II), is an essential bacterial enzyme that maintains the superhelical structure of DNA and is required for DNA replication and transcription, DNA repair, recombination, and transposition.

• Ratings for Levaquin in the Askapatient database
• Levaquin ratings on RevolutionHealth.com
• Levaquin user reviews for sinusitis (users rating 6.1 points), kidney infections (users rating 8.1 points), bronchitis and pneumonia (users rating 7 points), urinary tract infection, prostatitis on Drugs.com
• Levaquin user reviews about treatment success rate on DailyStrength.org
• Levaquin, Levofloxacin Forum - Topix
• Side effects:
• Levaquin side effects on MedicalNewsToday.com
• Levaquin Long term Side effects on MedHelp.org

• Levaquin official website

• 1. U.S. Food and Drug Administration. Levofloxacin (Levaquin) U.S. Prescribing Information Available at (PDF format)
• 2. Nelwan RH, Chen K, Nafrialdi , Paramita D. Open study on efficacy and safety of levofloxacin in treatment of uncomplicated typhoid fever. Southeast Asian J Trop Med Public Health. 2006 Jan;37(1):126-30.
• 3. Yagawa K. Latest industry information on the safety profile of levofloxacin in Japan. Chemotherapy. 2001;47 Suppl 3:38-43; discussion 44-8.
• 4. Kahn JB. Latest industry information on the safety profile of levofloxacin in the US. Chemotherapy. 2001;47 Suppl 3:32-7; discussion 44-8.
• 5. Mikamo H, Sato Y, Hayasaki Y, Hua YX, Tamaya T. Adequate levofloxacin treatment schedules for uterine cervicitis caused by Chlamydia trachomatis. Chemotherapy. 2000 Mar-Apr;46(2):150-2.
• 6. Yu VL, Greenberg RN, Zadeikis N, Stout JE, Khashab MM, Olson WH, Tennenberg AM. Levofloxacin efficacy in the treatment of community-acquired legionellosis. Chest. 2004 Jun;125(6):2135-9.
• 7. Bradley JS, Arguedas A, Blumer JL, Sa'ez-Llorens X, Melkote R, Noel GJ. Comparative study of levofloxacin in the treatment of children with community-acquired pneumonia. Pediatr Infect Dis J. 2007 Oct;26(10):868-78. PubMed

Last modified: April, 2010