Levofloxacin

Fluoroquinolone antibiotic, Antibacterial

Levofloxacin

Levaquin (US brand discontinued); generic and ophthalmic Quixin/Iquix

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Summary

Classes

Fluoroquinolone antibiotic, Antibacterial

Pharmacy

Starting dose

500-750 mg PO/IV once daily

Preparations

250, 500, 750 mg tablets; 25 mg/mL oral solution; 25 mg/mL IV (premix bags 250, 500, 750 mg); 0.5%, 1.5% ophthalmic solutions

US FDA Max

750 mg/d

Pharmacology

Routes

Oral, IV, topical ophthalmic

Onset

Hours

Duration

24 hours

Half-life

~6-8 hours

Bioavailability

~99% (oral; matched 1:1 IV-to-PO conversion)

Pregnancy

Avoid in pregnancy where alternatives exist (animal cartilage toxicity; class-wide concern).^{[citation needed]}

Legal status

Rx-only in US. Carries the same fluoroquinolone-class Boxed Warnings as ciprofloxacin: tendinitis/tendon rupture (especially elderly, corticosteroid co-use), peripheral neuropathy, CNS effects, worsening of myasthenia gravis

Purported mechanism

Levofloxacin (the L-enantiomer of ofloxacin) inhibits bacterial DNA gyrase (topoisomerase II) and topoisomerase IV, blocking supercoiling and decatenation required for DNA replication; the result is bactericidal.▲0▼ Among "respiratory fluoroquinolones" (with moxifloxacin and gemifloxacin) — broader S. pneumoniae and atypical coverage than ciprofloxacin, making it more useful in CAP. QT prolongation, hypoglycemia, and aortic dissection signals are recognized class effects.