What is the use of Levofloxacin (Levaquin)?

From the Guidelines

Levofloxacin is recommended as a treatment option for community-acquired pneumonia, particularly in adults with underlying comorbidities or those who have been exposed to antibiotic agents within the previous 3 months, at a dose of 750 mg daily for 5 days, as supported by the FDA approval and studies such as 1.

Key Points

• Levofloxacin is a fluoroquinolone antibiotic effective against various bacterial infections, including respiratory tract infections, urinary tract infections, skin infections, and certain sexually transmitted diseases.
• The typical adult dose is 500-750 mg once daily, with treatment duration ranging from 5-14 days depending on the infection type, as seen in studies like 1 and 1.
• It works by inhibiting bacterial DNA gyrase and topoisomerase IV, preventing DNA replication and ultimately killing bacteria.
• Common side effects include nausea, diarrhea, headache, and dizziness, while more serious adverse effects can include tendon rupture, peripheral neuropathy, and QT interval prolongation, as noted in 1.
• Levofloxacin should be taken with caution in elderly patients and those with kidney problems, where dose adjustments are often necessary, and patients should avoid antacids, iron, or multivitamins within 2 hours of taking it as these can reduce absorption.
• Due to increasing bacterial resistance and potential for serious side effects, levofloxacin is typically reserved for infections that haven't responded to other antibiotics or when other options aren't suitable, as recommended in guidelines such as 1.

Considerations

• The use of levofloxacin for pneumonia may delay the diagnosis of pulmonary tuberculosis and increase the risk of fluoroquinolone resistance, as mentioned in 1.
• Levofloxacin and moxifloxacin should be cautiously used in patients with risk or suspicion of tuberculosis.
• The impact on tuberculosis by these two new generation quinolones requires further investigation, highlighting the need for careful consideration and monitoring in clinical practice, as suggested by 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Overview of Levofloxacin

• Levofloxacin is a fluoroquinolone antibacterial agent with a broad spectrum of activity against Gram-positive and Gram-negative bacteria and atypical respiratory pathogens 2, 3.
• It is the L-form of the fluoroquinolone antibacterial agent, ofloxacin, and has improved activity against Streptococcus pneumoniae compared with ciprofloxacin or ofloxacin 2, 4.

Efficacy of Levofloxacin

• Levofloxacin has been shown to be effective in the treatment of various infections, including:
  • Community-acquired pneumonia (CAP) 2, 3, 5, 4.
  • Acute exacerbations of chronic bronchitis 2, 3, 4.
  • Acute maxillary sinusitis 2, 3, 4.
  • Uncomplicated and complicated skin and skin structure infections 2, 3, 4.
  • Uncomplicated and complicated urinary tract infections 2, 3, 5, 4.
• Clinical response rates with levofloxacin ranged from 86 to 95% versus 88 to 96% with comparator agents; bacteriological response rates were 88 to 95% and 86 to 98%, respectively 2.

Tolerability and Safety of Levofloxacin

• Levofloxacin is generally well tolerated, with the most frequently reported adverse events being nausea and diarrhoea 2, 3, 6.
• It has a low photosensitising potential and clinically significant cardiac and hepatic adverse events are rare 2, 3.
• However, levofloxacin can promote fluoroquinolone resistance among Streptococcus pneumoniae, and clinical failures may result from this therapy 6.

Dosage and Administration of Levofloxacin

• Levofloxacin can be administered in a once-daily regimen, with oral bioavailability allowing switching from intravenous to oral therapy without dosage adjustment 2, 4.
• A high-dose (750 mg) short-course (5 days) of once-daily levofloxacin is approved for use in the US in the treatment of CAP, acute bacterial sinusitis, complicated urinary tract infections, and acute pyelonephritis 5.