levofloxacin

levofloxacin

(lee voe flox' a sin)

Levaquin

Pregnancy Category C

Drug classes

Antibiotic

Fluoroquinolone

Therapeutic actions

Bactericidal: Interferes with DNA by inhibiting DNA gyrase replication in susceptible gram-negative and gram-positive bacteria, preventing cell reproduction.

Indications

·        Treatment of adults with community-acquired pneumonia, bacterial sinusitis caused by susceptible bacteria, including multidrug resistant strains

·        Treatment of acute exacerbation of chronic bronchitis caused by susceptible bacteria

·        Treatment of complicated and uncomplicated skin and skin structure infections caused by susceptible bacteria

·        Treatment of complicated and uncomplicated UTIs and acute pyelonephritis caused by susceptible bacteria

·        Treatment of chronic bacterial prostatitis due to Escherichia coli, Enterococcus faecalis, Staphylococcus

·        Treatment of nosocomial pneumonia due to methicillin-sensitive Staphylococcus aureus, Pseudomonas strains, Serratia, Escherichia coli, Klebsiella,Haemophilus influenzae, Streptococcus pneumoniae

·        Treatment of postexposure inhalational anthrax

·        Unlabeled uses: Traveler's diarrhea, epididymitis, gonococcal infection, pelvic inflammatory disease, urethritis

Contraindications and cautions

·        Contraindicated with allergy to fluoroquinolones, lactation.

·        Use cautiously with renal dysfunction, seizures, pregnancy.

Available forms

Tablets—250, 500, 750 mg; injection—500, 750 mg; premixed injection—250, 500, 750 mg; oral solution—25 mg/mL

Dosages

ADULTS

·        Community-acquired pneumonia: 500 mg daily PO or IV for 7–14 days.

·        Sinusitis: 500 mg daily PO or IV for 10–14 days or 750 mg/day PO or IV for 5 days.

·        Chronic bronchitis: 500 mg daily PO or IV for 7 days.

·        Skin infection: 500–750 mg daily PO or IV for 7–14 days.

·        UTIs: 250 mg daily PO or IV for 3–10 days.

·        Pyelonephritis: 250 mg daily PO or IV for 10 days.

·        Nosocomial pneumonia: 750 mg daily PO or IV for 7–14 days.

·        Chronic prostatitis: 500 mg/day PO for 28 days or 500 mg/day by slow IV infusion over 60 min for 28 days.

·        Postexposure anthrax: 500 mg/day PO or IV for 60 days.

PEDIATRIC PATIENTS

Not recommended in patients < 18 yr.

PATIENTS WITH RENAL IMPAIRMENT

Creatinine Clearance (mL/min)	Dose
50–80	No adjustment
20–49	500 mg initially, then 250 mg daily; or 750 mg, then 750 mg q 48 hr
10–19	500 mg initially, then 250 mg q 48 hr; or 750 mg, then 500 mg q 48 hr

·        Chronic prostatitis:

Creatinine Clearance (mL/min)	Dose
50–80	No adjustment
20–49	500 mg initially, then 250 mg daily
10–19	500 mg initially, then 250 mg q 48 hr

For patients on hemodialysis, use 250 mg q 48 hr.

Pharmacokinetics

Route	Onset	Peak	Duration
Oral	Varies	1–2 hr	3–5 hr
IV	Rapid	End of infusion	3–5 hr

Metabolism: Hepatic; T_1/2: 4–7 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Urine

IV facts

Preparation: No further preparation is needed if using the premixed solution; dilute single-use vials in 50–100 mL D₅W.

Infusion: Administer slowly over at least 60–90 min. Do not administer IM or subcutaneously.

Compatibilities: Can be further diluted in 0.9% sodium chloride injection, 5% dextrose injection, 5% dextrose/0.9% sodium chloride, 5% dextrose in lactated Ringer's, Plasma-Lyte 56 and 5% Dextrose injection, 9% dextrose/0.45% sodium chloride, 0.15% potassium chloride, sodium lactate injection.

Adverse effects

·        CNS: Headache, dizziness, insomnia, fatigue, somnolence, blurred vision

·        GI: Nausea, vomiting, dry mouth, diarrhea, abdominal pain (occur less with this drug than with oflaxacin), constipation, flatulence

·        Hematologic: Elevated BUN, AST, ALT, serum creatinine, and alkaline phosphatase; neutropenia, anemia

·        Other: Fever, rash, photosensitivity, muscle and joint tenderness, increased serum glucose

Interactions

Drug-drug

·        Decreased therapeutic effect with iron salts, sulcrafate, antacids, zinc, magnesium (separate by at least 2 hr)

·        Increased risk of seizures with NSAIDs; avoid this combination

Drug-alternative therapy

·        Increased risk of severe photosensitivity reactions if combined with St. John's wort therapy

Nursing considerations

Assessment

·        History: Allergy to fluoroquinolones, renal dysfunction, seizures, lactation, pregnancy

·        Physical: Skin color, lesions; T; orientation, reflexes, affect; mucous membranes, bowel sounds; LFTs, renal function tests; blood glucose (diabetics)

Interventions

·        Arrange for culture and sensitivity tests before beginning therapy.

·        Continue therapy as indicated for condition being treated.

·        Administer oral drug without regard to meals with a glass of water; separate oral drug from other cation administration, including antacids, by at least 2 hr.

·        Ensure that patient is well hydrated during course of therapy.

·        WARNING: Discontinue drug at any sign of hypersensitivity (rash, photophobia) or at complaint of tendon pain, inflammation, or rupture.

·        Monitor clinical response; if no improvement is seen or a relapse occurs, repeat culture and sensitivity test.

Teaching points

·        Take oral drug without regard to meals. If an antacid is needed, do not take it within 2 hours of levofloxacin dose.

·        Drink plenty of fluids while you are using this drug.

·        You may experience these side effects: Nausea, vomiting, abdominal pain (eat frequent small meals); diarrhea or constipation (consult nurse or physician); drowsiness, blurred vision, dizziness (use caution if driving or operating dangerous equipment); sensitivity to sunlight (avoid exposure, use a sunscreen if necessary).

·        Report rash, visual changes, severe GI problems, weakness, tremors.

Adverse effects in Italic are most common; those in Bold are life-threatening.