eMedExpert Home > Medications Facts > Levofloxacin (Levaquin)

Japanese biopharmaceutical companies have played an important part in new drug innovation. There are upwards of 117 useful antibiotics and related agents of Japanese origin, and among them, 41 agents have been licensed out around the world. The first antibiotic from Japan was colistin (discovered in 1950) followed by well-known agents such as mitomycin C (1955), kanamycin (1957), cefazolin (1969), amikacin (1972), piperacillin (1976), norfloxacin (1977), cefoperazone (1978), ofloxacin (1980), clarithromycin (1984), meropenem (1987), and others 3. The major group is the beta-lactam antibiotics (up to 15), followed by 7 fluoroquinolones.

Ofloxacin has been one of the major fluoroquinolones, with excellent pharmacokinetic properties and a wide antibacterial spectrum. Investigation of ofloxacin's racemic nature led to the discovery of a more active l-form, leading to the development of one of the latest and most advanced quinolones, levofloxacin.

Levofloxacin (the optical S-(-) isomer of ofloxacin) was developed by the Daiichi Pharmaceutical Co. Ltd. (now Daiichi Seiyaku Pharmaceutical Co. Ltd - one of Japan's largest pharmaceutical companies), in Japan. Levofloxacin has been developed to take advantage of antibacterial potency requiring only about half the usual dose of ofloxacin.

Levofloxacin was first launched in Japan in 1993 under the brand name Cravit. It is currently marketed in the U.S. by Ortho McNeil Pharmaceutical under the name Levaquin, under license from Daiichi. Sanofi-Aventis sells levofloxacin under the brand name Tavanic in Europe.

• Acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis.
• Acute bacterial exacerbation of chronic bronchitis due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, or Moraxella catarrhalis.
• Nosocomial pneumonia due to methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, or Streptococcus pneumoniae. Adjunctive therapy should be used as clinically indicated. Where Pseudomonas aeruginosa is a documented or presumptive pathogen, combination therapy with an anti-pseudomonal b-lactam is recommended.
• Community-acquired pneumonia due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydia pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae.
• Complicated skin and skin structure infections due to methicillin-susceptible Staphylococcus aureus, Enterococcus faecalis, Streptococcus pyogenes, or Proteus mirabilis.
• Uncomplicated skin and skin structure infections (mild to moderate) including abscesses, cellulitis, furuncles, impetigo, pyoderma, wound infections, due to methicillin-susceptible Staphylococcus aureus or Streptococcus pyogenes.
• Chronic bacterial prostatitis due to Escherichia coli, Enterococcus faecalis, or methicillin-susceptible Staphylococcus epidermidis.
• Complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa.
• Acute pyelonephritis (mild to moderate) caused by Escherichia coli.
• Uncomplicated urinary tract infections (mild to moderate) due to Escherichia coli, Klebsiella pneumoniae or Staphylococcus saprophyticus.
• Inhalational anthrax (post-exposure) - to reduce the incidence or progression of disease following exposure to aerosolized Bacillus anthracis

Levofloxacin is not effective in the treatment of syphilis.

• Pelvic inflammatory disease (PID)
• Gynecological infections 15
• Enterocolitis (Shigella spp.)
• Epididymitis (non-gonococcal) 16
• Gonococcal infections 17
• Legionnaires disease (Legionella pneumophila) 18
• Peritonitis
• Tuberculosis 9
• Community-acquired pneumonia in children 5
• Typhoid fever 7
• Endocarditis 14

• Advantages:
• convenient once-daily dosing - this is of particular benefit in those patients who may not be compliant
• rapidly bactericidal with a broad spectrum of activity 1
• better safety and tolerability 10-12 - one of the least likely fluoroquinolones to cause any cardiovascular effects 8, central nervous system disturbances and phototoxicity
• less significant drug interactions than with other fluoroquinolones, as levofloxacin does not have a major P-450 metabolism
• relatively low emergence of resistant organisms
• expanded gram-positive spectrum of activity (including Streptococcus pneumoniae)
• moderate anaerobic activity (most quinolones possess weak activity against anaerobes) 13
• levofloxacin is currently the only respiratory fluoroquinolone approved by the U.S. FDA for the treatment of nosocomial pneumonia
• excellent bioavailability both orally and intravenously
• treatment of acute exacerbations of chronic obstructive pulmonary disease with levofloxacin may reduce hospitalizations compared with standard antibiotics 6
• may be a good choice in persons with liver disease in whom other fluoroquinolones are contraindicated 19
• Disadvantages:
• not active against methicillin-resistant staphylococci, including S. aureus, S. epidermidis and S. haemolyticus 2
• risk of tendon ruptures (this risk may be increased in persons taking corticosteroids, especially the elderly) 4
• risk of peripheral neuropathy (nerve damage) 20, the symptoms include pain, burning, tingling, numbness, weakness, other alterations of sensation
• risk of prolongation of the QT interval, arrhythmia, and rare cases of torsades de pointes
• central nervous system and psychiatric side effects, such as convulsions, confusion, anxiety, depression, and insomnia
• expensive, not available in generic version
• may delay the fracture healing 21. The research data suggest that use of levofloxacin during early fracture repair may compromise the clinical course of fracture-healing.

Chemically, levofloxacin is the S-enantiomer (L-isomer) of ofloxacin, and has approximately twice the potency of ofloxacin, because the R+enantiomer (D-isomer) of ofloxacin is essentially inactive. In addition, the S-enantiomer (L-isomer) of ofloxacin, has substantially less toxicity.

Levofloxacin is a bactericidal antibiotic (kills the bacteria). It inhibits DNA-gyrase in susceptible organisms thereby inhibits relaxation of supercoiled DNA and promotes breakage of DNA strands. DNA gyrase (topoisomerase II), is an essential bacterial enzyme that maintains the superhelical structure of DNA and is required for DNA replication and transcription, DNA repair, recombination, and transposition.

If you experience pain in any tendon while taking Levofloxacin you should stop the medication and immediately contact your doctor.

61% of fluoroquinolone-associated tendon ruptures reported to the FDA (from November 1997 through December 31, 2005) were associated with levofloxacin 4. This drug has been the most heavily prescribed fluoroquinolone, accounting for approximately 45% of all fluoroquinolone prescriptions during that time. The mean age of patients with tendinopathy was 58.9 years for the cases in the FDA database.

Tendonitis causes pain and swelling in the affected tendon and is treated by removing the offending agent, anti-inflammatory medication, rest, and physical rehabilitation.

Although the exact mechanism of injury in fiuoroquinolone-associated tendinopathy is unknown, it is widely speculated that fiuoroquinolones are directly toxic to tendon fibers possibly associated with further decreased blood supply that particularly targets tendons that generally have a limited blood supply to begin with.

Tendinitis and tendon rupture most frequently involves the Achilles tendon, the tendon that runs from the back of the heel to the calf. Rupture of the Achilles tendon may require surgical repair. Levaquin has also been linked to tendon ruptures in the rotator cuff (shoulder), the biceps, the hand, and the thumb. This reaction appears to be more common in those taking steroid medications, in older patients, and in kidney transplant recipients, but many cases have occurred in people without any of these risk factors. The onset of symptoms is sudden and has occurred as soon as 24 hours after starting treatment with a fiuoroquinolone.

Levofloxacin half-life is 6-8 hours.

Levofloxacin does not interact with alcohol.

• Levofloxacin (Levaquin) versus Other Medications

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