Levoflox is a high-potency fluoroquinolone antibiotic indicated for the treatment of adults with severe bacterial infections. It exerts bactericidal activity by inhibiting bacterial DNA gyrase and topoisomerase IV, enzymes critical for DNA replication, transcription, and repair. Its broad spectrum of activity covers numerous Gram-positive, Gram-negative, and atypical pathogens, making it a versatile agent in both hospital and community settings. Proper diagnosis and susceptibility testing are essential prior to initiation to ensure appropriate use and mitigate resistance development.

Features

• Active ingredient: Levofloxacin (as hemihydrate)
• Available in 250 mg, 500 mg, and 750 mg film-coated tablets
• Also available as intravenous solution for infusion (5 mg/mL, 20 mL and 30 mL vials)
• Rapid and nearly complete oral bioavailability (~99%)
• Extensive tissue penetration, including lung, prostate, and skin
• Elimination half-life of approximately 6–8 hours, permitting once-daily dosing

Benefits

• Effective against a wide range of susceptible bacteria, reducing the need for multiple antibiotics
• High bioavailability ensures reliable systemic exposure whether administered orally or intravenously
• Once-daily dosing regimen enhances patient compliance and simplifies treatment schedules
• Proven efficacy in complicated infections including nosocomial pneumonia and chronic bacterial prostatitis
• Rapid onset of action helps control infection progression and reduce symptom severity
• Available in both oral and IV formulations allows for seamless step-down therapy

Common use

Levoflox is prescribed for the treatment of adults with infections caused by susceptible strains of designated microorganisms. Common indications include community-acquired pneumonia, complicated and uncomplicated urinary tract infections, acute bacterial exacerbation of chronic bronchitis, acute bacterial sinusitis, complicated skin and skin structure infections, chronic bacterial prostatitis, and inhalational anthrax (post-exposure). It is also used in the management of nosocomial pneumonia and as part of combination therapy for certain multidrug-resistant tuberculosis cases under specialist supervision.

Dosage and direction

Dosage must be individualized based on the type and severity of infection, renal function, and pathogen susceptibility. The usual adult dose for most infections is 250 mg to 750 mg orally or intravenously once every 24 hours. For patients with renal impairment (creatinine clearance <50 mL/min), dosage adjustment is required. Tablets should be swallowed whole with a full glass of water, with or without food, but preferably at the same time each day. Intravenous infusion should be administered over 60 minutes for 250 mg or 500 mg doses, and over 90 minutes for 750 mg doses, to minimize the risk of adverse reactions. The duration of therapy typically ranges from 7 to 14 days, depending on clinical response.

Precautions

Use with caution in elderly patients due to increased risk of tendon disorders and central nervous system effects. Avoid unnecessary exposure to sunlight or artificial UV light due to photosensitivity risk. Maintain adequate hydration to prevent crystaluria. Monitor for signs of peripheral neuropathy, and discontinue if symptoms occur. Use may be associated with exacerbation of myasthenia gravis. Diabetic patients should be monitored for blood glucose disturbances. Prolonged use may result in superinfection or Clostridium difficile-associated diarrhea. Not recommended for use in pediatric patients or during pregnancy unless potential benefits outweigh risks.

Contraindications

Hypersensitivity to levofloxacin, other quinolones, or any component of the formulation. History of tendon disorders related to quinolone use. Concurrent use with tizanidine due to risk of potentiated hypotensive and sedative effects. Avoid in patients with known QT prolongation, uncorrected hypokalemia, or those taking Class IA or III antiarrhythmic agents.

Possible side effect

Common adverse reactions (≥1%) include nausea, diarrhea, headache, insomnia, constipation, and dizziness. Less frequently, patients may experience tendonitis or tendon rupture, peripheral neuropathy, central nervous system effects (e.g., agitation, tremors, anxiety), hypoglycemia, photosensitivity, or elevated liver enzymes. Serious but rare side effects include QT prolongation, torsades de pointes, hepatotoxicity, severe skin reactions, and blood dyscrasias. Discontinue immediately at the first sign of rash, jaundice, tendon pain, or sensory/motor deficits.

Drug interaction

Levofloxacin may interact with multivalent cation-containing products (antacids, sucralfate, metal cations, dairy products), reducing absorption—administer at least 2 hours before or 4 hours after these agents. Concurrent use with corticosteroids may increase the risk of tendon rupture. May enhance effects of warfarin; monitor INR closely. Nonsteroidal anti-inflammatory drugs may increase CNS stimulation and seizure risk. Caution with drugs that prolong QT interval (e.g., erythromycin, antipsychotics, antiarrhythmics). May alter serum levels of theophylline or cyclosporine; monitor and adjust dose as needed.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next scheduled dose. In that case, skip the missed dose and resume the usual dosing schedule. Do not double the dose to make up for a missed one. Maintaining consistent antibiotic levels is important for efficacy, so patients should strive for adherence to the prescribed regimen.

Overdose

Symptoms of overdose may include nausea, vomiting, diarrhea, dizziness, tremors, confusion, seizures, or prolongation of the QT interval. Management is supportive; ensure adequate hydration and ECG monitoring. Levofloxacin is not efficiently removed by hemodialysis or peritoneal dialysis. In case of suspected overdose, seek immediate medical attention or contact a poison control center.

Storage

Store tablets and intravenous solution at room temperature (15–30°C or 59–86°F) in the original container, protected from light and moisture. Keep out of reach of children and pets. Do not use if the packaging is damaged, the solution is discolored, or particulate matter is present. Do not freeze. Discard any unused portion of the intravenous solution after single use.

Disclaimer

This information is intended for medical professionals and should not replace clinical judgment. Always confirm susceptibility testing before prescribing. Use only as directed by a qualified healthcare provider. The prescriber should be familiar with the complete prescribing information and latest clinical guidelines. Not all possible uses, interactions, or adverse effects are listed. Report any suspected adverse reactions to the appropriate regulatory authority.

Reviews

“Levoflox has been a reliable choice in our ICU for managing nosocomial pneumonia, with rapid clinical response and good tolerability in most patients.” – Infectious Disease Specialist, 12 years of experience
“Effective for complicated UTIs, though we remain vigilant for tendinopathy, especially in older adults.” – Urologist, 8 years of experience
“Used cautiously due to side effect profile, but invaluable for resistant pathogens when alternatives are limited.” – Internal Medicine Physician, 15 years of experience
“Step-down therapy from IV to oral is seamless, facilitating earlier discharge in eligible patients.” – Hospital Pharmacist, 10 years of experience
“Important drug in our arsenal, but requires careful patient selection and monitoring.” – Pulmonologist, 20 years of experience