Generic name: LevofloxacinBrand name: LevanClassification: Antibiotic, Fluoroquinolone

Therapeutic actions :Bactericidal: Interferes with DNA by inhibiting DNA synase replication in

susceptible gram-negative and gram-positive bacteria, preventing cell reproduction.

Indications: • Treatment of adults with community-acquired pneumonia, acute maxillarysinusitis caused by susceptible bacteria• Treatment of acute exacerbation of chronic bronchitis caused by susceptiblebacteria• Treatment of complicated and uncomplicated skin and skin structure infectionscaused by susceptible bacteria• Treatment of complicated and uncomplicated UTIs and acute pyelonephritiscaused by susceptible bacteria• Treatment of chronic bacterial prostatitis due to Escherichia coli, Enterococcusfaecalis, Staphylococcusspec ies• Treatment of nosocomial pneumonia due to methicillin-sensitiveStaphylococcusaureus, Pseudomonasstrains, Serratiaspec ies, Escherichia coli, Klebsiellaspecies, Haemophilus influenzae, Streptococcus pneumoniae

Contraindications and cautions: • Contraindicated with allergy to fluoroquinolones, lactation.• Use cautiously with renal dysfunction, seizures, pregnancy.

Available forms Tablets—250, 500, 750 mg; injection—500, 750 mg; premixed injection—250,

500, 750 mg

Dosages ADULTS

• Pneumonia: 500 mg daily PO or IV for 7–14 days.• Sinusitis: 500 mg daily PO or IV for 10–14 days.• Chronic bronchitis: 500 mg daily PO or IV for 7 days.• Skin infection: 500–750 mg daily PO or IV for 7–10 days.• UTIs: 250 mg daily PO or IV for 3–10 days.• Pyelonephritis: 250 mg daily PO or IV for 10 days.• Nosocomial pneumonia: 750 mg daily PO or IV for 7–14 days.• Chronic prostatitis: 50 mg/day PO for 28 days or 50 mg/day by slow IV infusion over 90 min for 28 days.

PEDIATRIC PATIENTS Not recommended in patients < 18 yr.

Creatinine Clearance (mL/min.) Dose50 – 80 No adjustment20 – 49 500 mg. initially, then 250 mg. daily10 – 19 500 mg. initially, then 250 mg. every 48 hrs.

PATIENTS WITH RENAL IMPAIRMENT

Creatinine Clearance (mL/min.) Dose50 – 80 No adjustment20 – 49 250 mg. daily10 – 19 250 mg. every 48 hrs.

Chronic prostatitis:For patients on hemodialysis, use 250 mg every 48 hr.

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PharmacokineticsRoute Onset Peak DurationOral Varies 1 – 2 hr 3 – 5 hrIV Rapid End of Infusion 3 – 5 hr

Metabolism: Hepatic; T1/2: 4–7 hrDistribution: Crosses placenta; enters breast milkExcretion: Urine

Adverse effects • CNS: Headache,dizziness, insomnia, fatigue, somnolence, blurred vision• GastroIntestinal: Nausea, vomiting, dry mouth, diarrhea, abdominal pain (occur less with this drug than with oflaxacin), constipation, flatulence• Hematologic: Elevated BUN, AST, ALT, serum creatinine, and alkalinephosphatase; neutropenia, anemia• Other: Fever, rash, photosensitivity, muscle and joint tenderness

(Adverse effects in Italic w/ Underline are most common; those in Bold w/ Underline are life-threatening.)

Drug-drug Interactions • Decreased therapeutic effect with iron salts, sulcrafate, antacids, zinc, magnesium(separate by at least 2 hr)• Increased risk of seizures with NSAIDs; avoid this combination

Drug-alternative therapy• Increased risk of severe photosensitivity reactions if combined with St. John'swort therapy.

Nursing considerations Assessment • History: Allergy to fluoroquinolones, renal dysfunction, seizures, lactation,pregnancy• Physical: Skin color, lesions; T; orientation, reflexes, affect; mucous membranes,bowel sounds; renal and liver function tests

Interventions • Arrange for culture and sensitivity tests before beginning therapy.• Continue therapy as indicated for condition being treated.• Administer oral drug 1 hr before or 2 hr after meals with a glass of water; separateoral drug from other cation administration, including antacids, by at least 2 hr.• Ensure that patient is well hydrated during course of therapy.• Discontinue drug at any sign of hypersensitivity (rash, photophobia) or atcomplaint of tendon pain, inflammation, or rupture.• Monitor clinical response; if no improvement is seen or a relapse occurs, repeatculture and sensitivity test.

Teaching points • Take oral drug on an empty stomach, 1 hr before or 2 hr after meals. If an antacidis needed, do not take it within 2 hr of levofloxacin dose.• Drink plenty of fluids while you are using this drug.• These side effects may occur: Nausea, vomiting, abdominal pain (eat frequentsmall meals); diarrhea or constipation (consult nurse or physician); drowsiness,blurred vision, dizziness (use caution if driving or operating dangerousequipment); sensitivity to sunlight (avoid exposure, use a sunscreen if necessary).• Report rash, visual changes, severe GI problems, weakness, tremors.

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