Levofloxacin

Provider Level

RN/Paramedic

Class

Fluoroquinolone antibiotic

Mechanism of Action

Inhibits bacterial DNA topoisomerase IV and DNA gyrase, preventing bacterial DNA replication, transcription, repair, and recombination.

Indications

Treatment of susceptible bacterial infections including community-acquired pneumonia, acute exacerbations of chronic bronchitis, skin structure infections, and complicated urinary tract infections.

Contraindications

Known hypersensitivity to levofloxacin or other fluoroquinolone antibiotics.

Routes

PO, IV

Onset / Duration

Onset: Rapid for IV, 1 to 2 hours for PO. Duration: 24 hours.

Adverse Effects

Nausea, diarrhea, headache, dizziness, insomnia, QTc prolongation, phototoxicity, tendon rupture, peripheral neuropathy.

Precautions & Interactions

Increased risk of tendinitis and tendon rupture, especially in older adults or concurrent corticosteroid use. May exacerbate myasthenia gravis muscle weakness. Caution in patients with known proarrhythmic conditions due to QTc prolongation risk. Risk of CNS effects including seizures and altered mental status.

Special Considerations

IV formulation must be infused slowly over 60 to 90 minutes to prevent hypotension. Ensure adequate patient hydration to prevent crystalluria. For PO administration, do not give simultaneously with antacids, sucralfate, or metal cations like iron or zinc.