Levofloxacin (Levaquin) Medication

Levofloxacin (brand name: Levaquin) is a third generation broad spectrum fluoroquinolone antibiotic. This drug is used to treat bacterial infections including sinusitis, chronic bronchitis, pneumonia, skin and skin structure infections, pyelonephritis (mild to moderate), urinary tract infections, inhalational anthrax (to prevent the development of inhalational anthrax following exposure to Bacillus anthracis).

Off-label uses (not FDA-approved)

• Pelvic inflammatory disease
• Typhoid fever
• Legionnaires disease (Legionella pneumophila)
• Tuberculosis

Levofloxacin Advantages & Benefits

• Powerful broad-spectrum antibiotic.
• Convenient dosing regimen - has a long half-life and can be given once daily.
• Very low phototoxicity-inducing potential in comparison with other fluoroquinolones. Although phototoxicity is a theoretical concern, it is definitely less of a problem than with other quinolones such as lomefloxacin and sparfloxacin.
• Less significant drug interactions than with other fluoroquinolones. No interaction with drugs such as theophylline.
• Effective antibiotic for highly resistant pneumococci2
• Highly active against atypical respiratory pathogens (Legionella pneumophila, Mycoplasma pneumoniae, Chlamydia pneumoniae )3
• Fewer problems with resistance than with older quinolones. Unlike many of the other quinolones, levofloxacin uses two separate mechanisms to avoid the development of resistance.
• The great thing about levofloxacin is that most of the time one pill can replace a whole intravenous (IV) bag. Oral levofloxacin can be used in place of other injectable antibiotics. One levofloxacin 500 mg pill may provide broader coverage than most b.i.d. or t.i.d. intravenous therapy cephalosporins.
• Improved activity against Chlamydia.

Levofloxacin Drawbacks

• Risk of tendon damage. May cause tendonitis, arthropathies, and ruptures of the shoulder, hand, Achilles tendon or other tendons. This risk may be increased in patients receiving concomitant corticosteroids, especially the elderly.
• Risk of peripheral neuropathy (nerve damage).
• Expensive.

How does Levofloxacin work?

Levofloxacin works by entering the bacterial cell and inhibiting a DNA-gyrase which is involved in the production of genetic material (DNA). This prevents the bacteria from reproducing and their growth is stopped.

Levofloxacin versus Cefdinir
The multicenter, double-blind study compared the efficacy and tolerability of cefdinir and levofloxacin in patients with acute rhinosinusitis. Clinical cure rates in the cefdinir and levofloxacin groups were 83% and 86%. The study have shown that cefdinir and levofloxacin have comparable efficacy in the treatment of infections classified as moderate to severe. The incidence of adverse events was generally comparable in the 2 treatment groups. However, cefdinir had greater rate of incidence of vaginal moniliasis in women (11% vs 0%), drug-related diarrhea (8% vs 1%). Levofloxacin had a higher incidence of insomnia (0% for cefdinir vs 4% for levoflxacin)1.

Five Days of Levaquin (levofloxacin) as Effective as 10 Days of Ciprofloxacin in Complicated Urinary Tract Infections and Acute Pyelonephritis.
May 19, 2007 Johnson & Johnson

The multi-center, double-blind, randomized study of 1,109 patients with either cUTI or AP was designed to assess the efficacy and safety of Levaquin (750 mg QD / five days) versus ciprofloxacin (400/500 mg BID / 10 days). The results of the study have shown that a short course of five, once-daily doses of Levaquin 750 mg is as effective as 10 twice-daily doses of ciprofloxacin in treating complicated urinary tract infections and acute pyelonephritis.

• 1. Henry DC, Kapral D, Busman TA, Paris MM. Cefdinir versus levofloxacin in patients with acute rhinosinusitis of presumed bacterial etiology: a multicenter, randomized, double-blind study. Clin Ther. 2004 Dec;26(12):2026-33. PubMed
• 2. Cunha BA. Clinical relevance of penicillin-resistant Streptococcus pneumoniae. Semin Respir Infect. 2002 Sep;17(3):204-14. PubMed
• 3. Critchley IA, Jones ME, Heinze PD, Hubbard D, Engler HD, Evangelista AT, Thornsberry C, Karlowsky JA, Sahm DF. In vitro activity of levofloxacin against contemporary clinical isolates of Legionella pneumophila, Mycoplasma pneumoniae and Chlamydia pneumoniae from North America and Europe. Clin Microbiol Infect. 2002 Apr;8(4):214-21. PubMed