Levofloxacin
General Information
Fluoroquinolone
Restricted formulary antimicrobial: For details see OUH netFormulary
AWaRe antibiotic classification: 'Watch'. Use as per guidelines. All other indications to be discussed with Micro/ID.
For all information regarding interactions, contraception, pregnancy and breastfeeding and additional information, see BNF and Summary of Product Characteristics (SPC).
MHRA Drug Safety Updates
Fluoroquinolones, including levofloxacin are associated with disabling and potentially long-lasting or irreversible side effects. See Fluoroquinolone antibiotics - severe adverse effects
When using fluoroquinolones:
- DO NOT prescribe for:
- non-severe or self-limiting infections.
- mild to moderate infections (unless other antibiotics that are commonly recommended for these infections are considered inappropriate).
- DO read the Antimicrobial Guideline section: Fluoroquinolone antibiotics - severe adverse effects
- DO ensure penicillin allergies are properly clarified and consider de-labelling in appropriate patients to avoid the use of fluoroquinolones. See guidelines: Penicillin allergy assessment and overview and Penicillin allergy challenge and delabelling
- DO ensure all patients are given the MHRA fluoroquinolone patient leaflet (this is usually given to patients with their discharge and outpatient medications).
Dosing
| Oral levofloxacin | Intravenous levofloxacin | |
| Standard dose | 500mg OD | 500mg OD |
| Community acquired pneumonia and Hospital acquired pneumonia | 500mg BD | 500mg BD |
| H. pylori | 250mg BD |
Note: This does not include Drug Resistant tuberculosis. The TB team will advise about treatment regimens and dosing.
Obesity
No dose adjustment required. Use the top end of usual dosing range after considering renal function.
Renal and hepatic impairment
Renal impairment
For treatment doses only. This does not apply to H.pylori eradication regimes or TB treatment. Please speak to pharmacist.
|
Creatinine Clearance (mL/min)* |
Usual levofloxacin dose 500mg OD |
Usual levofloxacin dose 500mg BD |
|
Over 50 |
Dose as in normal renal function |
|
|
20-50 |
First dose 500mg then 250mg OD |
First dose 500mg then 250mg BD |
|
10-19 |
First dose 500mg then 250mg every 48 hours |
First dose 500mg then 250mg OD |
|
Less than 10 |
First dose 500mg then 250mg every 48 hours |
First dose 500mg then 250mg every 48 hours |
|
HD/HDF/High Flux/PD |
Not dialysed. First dose 500mg then 250mg every 48 hours |
Not dialysed. First dose 500mg then 250mg every 48 hours |
*dose ranges use creatinine clearance, rather than eGFR.
Hepatic impairment:
No dose adjustment required.
Cases of hepatic necrosis up to life threatening hepatic failure have been reported, primarily in patients with severe underlying diseases, e.g. sepsis. In the event of any signs and symptoms of hepatic disease (such as anorexia, jaundice, dark urine, pruritus, or tender abdomen), treatment should be discontinued.