Levofloxacin: Side Effects, Contraindications and Dosage
- Fluoroquinolones (1/5): general pharmacology
- Fluoroquinolones (2/5): ciprofloxacin
- Fluoroquinolones (3/5): levofloxacin
- Fluoroquinolones (4/5): ofloxacin
- Fluoroquinolones (5/5): norfloxacin
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, epididymitis or perioperative antibiotic prophylaxis for transurethral surgery.
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 |
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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
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Deutsche Version: Nebenwirkungen, Kontraindikationen und Dosierung von Levofloxacin
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