What are the indications for Levofloxacin (levofloxacin)?

Levofloxacin Indications

Levofloxacin is FDA-approved for multiple infections including nosocomial and community-acquired pneumonia, acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, complicated and uncomplicated skin infections, chronic bacterial prostatitis, complicated and uncomplicated urinary tract infections, acute pyelonephritis, inhalational anthrax, and plague. 1

Respiratory Tract Infections

Community-Acquired Pneumonia (CAP)

• Approved for 5-day or 7-14 day treatment regimens depending on severity and pathogens

• Effective against common CAP pathogens including:

  • Streptococcus pneumoniae (including multi-drug resistant strains)
  • Haemophilus influenzae
  • Haemophilus parainfluenzae
  • Klebsiella pneumoniae
  • Moraxella catarrhalis
  • Chlamydophila pneumoniae
  • Legionella pneumophila
  • Mycoplasma pneumoniae 1

• Dosing: 750 mg daily for 5 days is currently FDA-approved for adults with pneumonia 2

• Not first-line for previously healthy adults, but recommended for adults with:

  • Underlying comorbidities
  • Antibiotic exposure within previous 3 months
  • Risk of antibiotic-resistant pathogens 2

Nosocomial Pneumonia

• Indicated for hospital-acquired pneumonia caused by:
  • Methicillin-susceptible Staphylococcus aureus
  • Pseudomonas aeruginosa
  • Serratia marcescens
  • Escherichia coli
  • Klebsiella pneumoniae
  • Haemophilus influenzae
  • Streptococcus pneumoniae 1
• Combination therapy with an anti-pseudomonal β-lactam is recommended when Pseudomonas aeruginosa is suspected 1

Acute Bacterial Sinusitis

• Approved for both 5-day and 10-14 day treatment regimens
• Effective against Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 1

Acute Bacterial Exacerbation of Chronic Bronchitis

• Indicated for treatment of methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, or Moraxella catarrhalis 1

Skin and Skin Structure Infections

Complicated Skin and Skin Structure Infections

• Effective against methicillin-susceptible Staphylococcus aureus, Enterococcus faecalis, Streptococcus pyogenes, and Proteus mirabilis 1

Uncomplicated Skin and Skin Structure Infections

• Indicated for mild to moderate infections including abscesses, cellulitis, furuncles, impetigo, pyoderma, and wound infections caused by methicillin-susceptible Staphylococcus aureus or Streptococcus pyogenes 1

Genitourinary Tract Infections

Urinary Tract Infections (UTIs)

• Approved for both uncomplicated and complicated UTIs
• Available as 5-day or 10-day treatment regimens for complicated UTIs
• Effective against common uropathogens including Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, Enterobacter cloacae, and Pseudomonas aeruginosa 1
• For pyelonephritis, levofloxacin 750 mg once daily is recommended as a parenteral treatment option 2

Chronic Bacterial Prostatitis

• Indicated for infections caused by Escherichia coli, Enterococcus faecalis, or methicillin-susceptible Staphylococcus epidermidis 1

Other Indications

Inhalational Anthrax (Post-Exposure)

• Indicated to reduce incidence or progression of disease following exposure to aerosolized Bacillus anthracis 1

Plague

• Indicated for treatment of pneumonic and septicemic plague due to Yersinia pestis
• Also indicated for prophylaxis for plague in adults and pediatric patients ≥6 months of age 1

Clinical Considerations and Cautions

• Culture and susceptibility testing should be performed before treatment when possible 1
• Resistance monitoring is important, particularly for Pseudomonas aeruginosa which may develop resistance rapidly during treatment 1
• Fluoroquinolones should be used judiciously to minimize resistance development, particularly in Streptococcus pneumoniae 3
• Levofloxacin should be considered an alternative rather than first-line agent for routine community-acquired infections to preserve its effectiveness 3

Dosing Considerations

• Higher dose (750 mg daily) is designed to overcome the most common mechanism for fluoroquinolone resistance development 2
• Once-daily dosing and bioequivalence between oral and IV formulations allow for convenient sequential therapy 4

Levofloxacin remains a valuable antimicrobial option for various infections, but its use should be carefully considered to minimize resistance selection and maintain its effectiveness for severe infections and against resistant pathogens.