Levofloxacin
LEVAQUIN
Pronunciation: lee-voe-FLOX-a-sin
“Leave a flock of cinnamon queens”
What it isFluoroquinolone inhibiting topoisomerase IV and DNA gyrase; pneumonia, urinary and intra-abdominal infection.
Why this oneIt bridges respiratory and urinary niches: better pneumococcal coverage than ciprofloxacin, with urinary penetration moxifloxacin lacks.
What limits itTendon rupture, neuropathy, CNS effects and QT prolongation. Cations bind it; renally adjusted.
Levofloxacin prescription history
Animated chart of estimated U.S. prescriptions per year, Quinolone antibacterials (1964–2026). Levofloxacin enters in 1997 (estimated).
FDA-approved for
- bacterial infections (1996)
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityTendon/aortic injury, dysglycemia and CNS effects; QT or CYP1A2 risk varies by agent.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Nosocomial pneumonia | Adults (CLcr ≥50) | 750 mg QD | 750 mg QD ×7–14d | 750 mg QD |
| Community-acquired pneumonia | Adults | 500 mg QD ×7–14d or 750 mg QD ×5d | 500–750 mg QD | 750 mg QD |
| Complicated skin/skin-structure infection | Adults | 750 mg QD ×7–14d | 750 mg QD | 750 mg QD |
| Uncomplicated skin/skin-structure infection | Adults | 500 mg QD ×7–10d | 500 mg QD | 500 mg QD |
| Chronic bacterial prostatitis | Adults | 500 mg QD ×28d | 500 mg QD | 500 mg QD |
| Complicated UTI / acute pyelonephritis | Adults | 750 mg QD ×5d or 250 mg QD ×10d | 250–750 mg QD | 750 mg QD |
| Uncomplicated UTI | Adults | 250 mg QD ×3d | 250 mg QD | 250 mg QD |
| Acute bacterial exacerbation of chronic bronchitis | Adults | 500 mg QD ×7d | 500 mg QD | 500 mg QD |
| Acute bacterial sinusitis | Adults | 750 mg QD ×5d or 500 mg QD ×10–14d | 500–750 mg QD | 750 mg QD |
| Inhalational anthrax (post-exposure) / plague | Adults & peds ≥50 kg (≥6 mo) | 500 mg q24h | 500 mg q24h (anthrax 60d; plague 10–14d) | 500 mg q24h |
| Inhalational anthrax (post-exposure) / plague | Peds 30–<50 kg | 250 mg q12h | 250 mg q12h | 250 mg q12h |
Renal CrCl ≥50: no adjustment. By usual regimen → CrCl 20–49 | 10–19 | HD/CAPD: 750 mg q24h → 750 mg q48h | 750 mg initial, then 500 mg q48h | same as 10–19; 500 mg q24h → 500 mg initial, then 250 mg q24h | 500 mg initial, then 250 mg q48h | same as 10–19; 250 mg q24h → no adjustment | 250 mg q48h (uncomplicated UTI: no adjustment) | no information on dosing adjustment. No supplemental dose after HD/CAPD.
Hepatic Undefined
Instructions
- Tablets: take with or without food; maintain adequate hydration.
- Give ≥2 hr before/after antacids (Mg/Al), sucralfate, metal cations (iron), multivitamins with zinc, or didanosine.
- Tablets only for pediatric patients ≥30 kg.
- Missed dose: take up to 8 hr before next dose.
Available strengths
- tab 250, 500, 750 mg
- sol 250 mg/10 mL
- inj 5, 25 mg/mL
- drops 0.5 %
Contraindications
- Known hypersensitivity to levofloxacin or other quinolones
Cautions
- Tendinitis/tendon rupture (↑ in >60 yr, corticosteroids, transplant)
- Peripheral neuropathy (may be irreversible)
- CNS effects (seizures, psychiatric reactions, ↑intracranial pressure)
- Exacerbation of myasthenia gravis — avoid
- Hypersensitivity/anaphylaxis after first dose
- Hepatotoxicity
- Aortic aneurysm/dissection risk
- C. difficile-associated diarrhea
- QT prolongation/torsades — avoid with hypokalemia, QT-prolonging drugs
- Blood glucose disturbances; photosensitivity
Adverse reactions
- Nausea, headache, diarrhea
- Insomnia, constipation, dizziness
Pregnancy Human data have not identified drug-associated risk; not teratogenic in animals.
Lactation Present in human milk; breastfeeding not recommended during and for 2 days after last dose (may pump and discard).
Cost
Generic entryBy 2023
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Memory aids: interaction avatars
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Self-check
- What absorption interaction matters with levofloxacin?
Cations bind it. - What urinary advantage does levofloxacin have over moxifloxacin?
Urinary penetration.