Levofloxacin

A to Z Drug Facts

 Action Interferes with microbial DNA synthesis.

 Indications Treatment of infections of maxillary sinus, upper and lower respiratory tracts, skin and skin structure, and urinary tract caused by susceptible organisms; acute pyelonephritis caused by E. coli.

Ophthalmic use: Treatment of conjunctivitis caused by susceptible strains of aerobic gram-positive and aerobic gram-negative microorganisms.

 Contraindications Hypersensitivity to fluoroquinolones, quinolone antibiotics, or any product component; tendonitis or tendon rupture associated with quinolone use.

 Route/Dosage

UTIs

ADULTS: PO/IV 250 mg q 24 hr.

Infections of Maxillary Sinus, Respiratory Tract, Skin and Skin Structure

ADULTS: PO/IV 500 mg q 24 hr.

Bacterial Conjunctivitis

ADULTS AND CHILDREN ³ 1 YR: Topical Days 1 and 2: Instill 1 to 2 drops in affected eye(s) q 2 hr while awake, up to 8 times daily. Days 3 through 7: Instill 1 to 2 drops in affected eye(s) q 4 hr while awake, up to 4 times daily.

Acute Pyelonephritis

ADULTS: PO/IV 250 mg q 24 hr for 10 days.

 Interactions

Antacids, iron salts, zinc salts, sucralfate: May decrease oral absorption of levofloxacin. Stagger administration times.

 Lab Test Interferences None well documented.

 Adverse Reactions

CNS: Headache; insomnia; dizziness. DERM: Pruritis. GI: Nausea; diarrhea; constipation; vomiting; abdominal pain; dyspepsia; flatulence. GU: Vaginitis. OTHER: Injection site reaction; chest pain; back pain.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy in children < 18 yr not established. Ophthalmic: Safety and efficacy in children < 1 yr not established. Convulsions: CNS stimulation can occur; use drug with caution in patients with known or suspected CNS disorders. Photosensitivity: Moderate-to-severe reactions may occur; avoid excessive sunlight and ultraviolet light. Pseudomembranous colitis: Consider possibility in patients who develop diarrhea. Renal impairment: Reduced clearance may occur; adjust dose downward accordingly in Ccr < 50 mL/min. Refer to manufacturer's package insert for dose calculations. Hypersensitivity reactions: Serious and potentially fatal reactions have occurred with drugs in this class. Discontinue drug if allergic reaction occurs.

 Administration/Storage

Oral

• Administer without regard to food with full glass of water.
• Administer 2 hr before or after the following: antacids containing magnesium or aluminum; sucralfate; metal cations (eg, iron); and multivitamins containing zinc.
• Store at room temperature in tightly closed container.

IV Solution

• Levofloxacin in single-use vial (25 mg/mL) must be diluted before use.
• Do not use if solution is cloudy or if particulate matter is noted.
• Administer slowly over a period of not < 60 min.
• Diluted solution (5 mg/mL) is stable for 72 hr at room temperature (< 77°F), 14 days when refrigerated; and 6 mo when frozen.
• Thaw frozen solutions at room temperature or in refrigerator. Do not force thaw by microwave or bath immersion. Do not refreeze after initial thawing.

Ophthalmic

• Do not inject subconjunctivally or introduce directly into the anterior chamber of eye.
• Store at room temperature.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Obtain baseline CBC, renal, and liver function tests, and electrolytes.
• Obtain baseline vital signs. Monitor vital signs at least bid while administering medication.
• Assess for any skin rashes. Notify physician if skin rash occurs.
• Monitor I&O.
• Monitor for signs of anaphylaxis (eg, pharyngeal or facial edema, dyspnea, urticaria, itching).
• Monitor patterns of elimination and stool consistency.
• Monitor for signs of superinfection.
• Encourage fluid intake.
• Frequently assess patency of IV site and observe for signs of phlebitis during therapy.
• Notify physician if vomiting, fatigue, lymphocytopenia, increased liver function test results, seizures, or vital disturbances occur.
• Notify physician if symptoms of pseudomembranous colitis occur (eg, loose or foul-smelling stools) or if symptoms of CNS stimulation occur (eg, tremor, restlessness, confusion).

 Patient/Family Education

Ophthalmic

• Advise patient to avoid contaminating applicator tip with material from eyes, fingers, or other sources.
• Inform patient that tablets may be taken orally without regard to meals.
• Inform patient to take tablets 2 hr before or after antacids containing magnesium or aluminum, as well as sucralfate, iron tablets, and multivitamins containing zinc.
• Instruct patient to drink sufficient fluids to ensure adequate urinary output.
• Caution patient to avoid exposure to sunlight and to use sunscreen or protective clothing until tolerance is determined.
• Instruct patient to report signs of bacterial or fungal overgrowth (eg, black, furry appearance of tongue, vaginal itching or discharge, loose or foul-smelling stools).
• Advise patient to discontinue use immediately and contact physician at first sign of a rash or allergic reaction.
• Caution patient that drug may cause dizziness or lightheadedness and to use caution while driving or performing other tasks requiring mental alertness.
• Caution patient against doubling a dose to “catch up” unless advised by a physician. Instruct patient to contact physician if >1 dose is missed.
• Emphasize importance of completing entire dose regimen.
• Advise patient not to take any otc medication without consulting physician.
• Instruct diabetic patients to stop treatment and notify physician if a hypoglycemic reaction occurs.
• Instruct patient to stop treatment and inform physician if experiencing pain, inflammation, or rupture of tendon, and to rest of refrain from exercise until diagnosis of tendonitis or tendon rupture is excluded.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts