Does Levquin (Levofloxacin) cover Gram-negative rods?

From the Guidelines

Yes, Levaquin (levofloxacin) does cover gram-negative rods, including Pseudomonas aeruginosa, as evidenced by the Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults 1. Levofloxacin is a fluoroquinolone antibiotic that has broad-spectrum activity against many gram-negative bacteria, including Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. It is effective against these organisms because it inhibits bacterial DNA gyrase and topoisomerase IV, enzymes necessary for bacterial DNA replication. The typical adult dose of levofloxacin is 500-750 mg once daily, with duration depending on the infection being treated (usually 5-14 days). Some key points to consider when using levofloxacin include:

• Resistance to fluoroquinolones has been increasing among certain gram-negative bacteria, particularly in healthcare settings 1.
• Levofloxacin also has activity against some gram-positive organisms and atypical pathogens, making it useful for respiratory, urinary tract, skin, and soft tissue infections 1.
• Patients should be monitored for potential side effects including tendon inflammation, CNS effects, and QT prolongation.
• The use of levofloxacin in combination with other antibiotics, such as a beta-lactam, may be recommended in certain cases, such as for the treatment of Pseudomonas aeruginosa infections 1.

From the FDA Drug Label

Levofloxacin has in vitro activity against Gram-negative and Gram-positive bacteria fections as described in Indications and Usage (1): Gram-Negative Bacteria Enterobacter cloacae Escherichia coli Haemophilus influenzae Haemophilus parainfluenzae Klebsiella pneumoniae Legionella pneumophila Moraxella catarrhalis Proteus mirabilis Pseudomonas aeruginosa Serratia marcescens

Yes, levofloxacin covers Gram-negative rods, including:

• Enterobacter cloacae
• Escherichia coli
• Klebsiella pneumoniae
• Proteus mirabilis
• Serratia marcescens 2

From the Research

Levaquin Coverage of Gram-Negative Rods

• Levaquin, also known as levofloxacin, is a fluoroquinolone antibacterial agent with a broad spectrum of activity against Gram-positive and Gram-negative bacteria, including atypical respiratory pathogens 3.
• It is active against both penicillin-susceptible and penicillin-resistant Streptococcus pneumoniae, and has been shown to be effective in the treatment of infections of the respiratory tract, genitourinary tract, skin, and skin structures 3.
• The efficacy of levofloxacin against Gram-negative rods, such as Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa, has been demonstrated in various studies 3, 4, 5, 6.
• However, the emergence of resistance to levofloxacin and other fluoroquinolones has been reported, particularly in Gram-negative bacteria 4, 6.
• The use of levofloxacin and other antimicrobial agents has been associated with the development of resistance in Gram-negative bacteria, highlighting the need for prudent use and antimicrobial stewardship 4, 6, 7.

Specific Gram-Negative Rods Covered by Levaquin

• Escherichia coli: levofloxacin has been shown to be effective against E. coli, including strains resistant to other antibiotics 3, 5.
• Klebsiella pneumoniae: levofloxacin has been shown to be effective against K. pneumoniae, including strains resistant to other antibiotics 3, 5.
• Pseudomonas aeruginosa: levofloxacin has been shown to be effective against P. aeruginosa, although resistance has been reported 3, 5, 7.
• Other Gram-negative rods: levofloxacin has been shown to be effective against other Gram-negative rods, including Enterobacter cloacae, Serratia marcescens, and Proteus spp. 3, 6.