You are here: Urology Textbook > Drugs in Urology > Antibiotics > Levofloxacin

Levofloxacin: Side Effects, Contraindications and Dosage

Review literature: (Simon und Stille, 1997).

Mechanism of Action of Levofloxacin

Levofloxacin is a fluoroquinolone antibiotic, which interferes with the bacterial DNA synthesis via inhibition of the DNA gyrase or topoisomerase II. Fluoroquinolone antibiotics are bactericidal.

Indications for Levofloxacin

Levofloxacin is active against a variety of bacteria:

Gram-negative pathogens including Pseudomonas, Mycoplasma, Chlamydia,..
Gram-positive pathogens, but not Pneumococci or Enterococci
Some anaerobic bacteria

Urologic indications for levofloxacin are urinary tract infections, prostatitis, acute pyelonephritis, or epididymitis.

Pharmacokinetics of Levofloxacin

Complete bioavailability after oral administration, maximum concentration in serum within 60 min after oral administration.
Good tissue penetration
Half-life of 6–8 h, renal elimination.

Side Effects of Levofloxacin

Gastrointestinal side effects: Nausea, vomiting, diarrhea, pseudomembranous colitis
Neurotoxicity with headache, dizziness, psychosis and seizures.
Allergy. Rarely serious allergic skin reactions.
Photosensitization
Orthopedic side effects: cartilage damage, tendon damage with spontaneous tendon rupture.
Rarely alterations of the blood count

Interactions with Levofloxacin:

Do not give iron salts or magnesium or aluminum-containing antacids together with levofloxacin. Levofloxacin increases half life of cyclosporine and increases warfarin effect.

Contraindications to Levofloxacin

Pregnancy, lactation and children
Epilepsy
Patients with tendon damage after fluoroquinolone administration

Dosage of Levofloxacin

Dosage depends on the severity of the infection:

Oral or intravenous dosage: 250–500 mg 1-0-1 (Martin et al., 1998)
Reduced dosage in impaired renal function (GFR below 50 ml/min)

Fluoroquinolones

Index

Ofloxacin

Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

References

Auquer u.a. 2002 AUQUER, F. ; CORDON, F. ; GORINA, E. ; CABALLERO, J. C. ; ADALID, C. ; BATLLE, J.: Single-dose ciprofloxacin versus 3 days of norfloxacin in uncomplicated urinary tract infections in women.
In: Clin Microbiol Infect
8 (2002), Nr. 1, S. 50–4

Henry u.a. 2002 HENRY, Jr. ; BETTIS, R. B. ; RIFFER, E. ; HAVERSTOCK, D. C. ; KOWALSKY, S. F. ; MANNING, K. ; HAMED, K. A. ; CHURCH, D. A.: Comparison of once-daily extended-release ciprofloxacin and conventional twice-daily ciprofloxacin for the treatment of uncomplicated urinary tract infection in women.
In: Clin Ther
24 (2002), Nr. 12, S. 2088–104

Krcmery und Naber 1999 KRCMERY, S. ; NABER, K. G.: Ciprofloxacin once versus twice daily in the treatment of complicated urinary tract infections. German Ciprofloxacin UTI Study Group.
In: Int J Antimicrob Agents
11 (1999), Nr. 2, S. 133–8

Martin u.a. 1998 MARTIN, S. J. ; MEYER, J. M. ; CHUCK, S. K. ; JUNG, R. ; MESSICK, C. R. ; PENDLAND, S. L.: Levofloxacin and sparfloxacin: new quinolone antibiotics.
In: Ann Pharmacother
32 (1998), Nr. 3, S. 320–36

Mombelli u.a. 1999 MOMBELLI, G. ; PEZZOLI, R. ; PINOJA-LUTZ, G. ; MONOTTI, R. ; MARONE, C. ; FRANCIOLLI, M.: Oral vs. intravenous ciprofloxacin in the initial empirical management of severe pyelonephritis or complicated urinary tract infections: a prospective randomized clinical trial.
In: Arch Intern Med
159 (1999), Nr. 1, S. 53–8

Naber u.a. 1999 NABER, K. G. ; THEURETZBACHER, U. ; MONEVA-KOUCHEVA, G. ; STASS, H.: Urinary excretion and bactericidal activity of intravenous ciprofloxacin compared with oral ciprofloxacin.
In: Eur J Clin Microbiol Infect Dis
18 (1999), Nr. 11, S. 783–9

Raz u.a. 2000 RAZ, R. ; NABER, K. G. ; RAIZENBERG, C. ; ROHANA, Y. ; UNAMBA-OPARAH, I. ; KORFMAN, G. ; YANIV, I.: Ciprofloxacin 250 mg twice daily versus ofloxacin 200 mg twice daily in the treatment of complicated urinary tract infections in women.
In: Eur J Clin Microbiol Infect Dis
19 (2000), Nr. 5, S. 327–31

Reid u.a. 2000 REID, G. ; POTTER, P. ; DELANEY, G. ; HSIEH, J. ; NICOSIA, S. ; HAYES, K.: Ofloxacin for the treatment of urinary tract infections and biofilms in spinal cord injury.
In: Int J Antimicrob Agents
13 (2000), Nr. 4, S. 305–7

Simon und Stille 1997 SIMON, C. ; STILLE, W.: Antibiotika-Therapie in Klinik und Praxis.
9. Auflage.
Stuttgart New York : Schattauer, 1997

Talan u.a. 2004 TALAN, D. A. ; KLIMBERG, I. W. ; NICOLLE, L. E. ; SONG, J. ; KOWALSKY, S. F. ; CHURCH, D. A.: Once daily, extended release ciprofloxacin for complicated urinary tract infections and acute uncomplicated pyelonephritis.
In: J Urol
171 (2004), Nr. 2 Pt 1, S. 734–9

Deutsche Version: Nebenwirkungen, Kontraindikationen und Dosierung von Levofloxacin