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Paul A. Pham, Pharm.D. and John G. Bartlett, M.D.
09-01-2009
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Available formulation in Zambia: tablets: 250 mg; 500 mg; 750 mg
- Community acquired pneumonia: 500 mg qdx 7 days.
- Nosocomial pneumonia: 750 mg once daily x 7-14 days.
Zambia Information Author: Paul A. Pham, Pharm.D.
- Acute bacterial exacerbations of chronic bronchitis (ABECB); acute bacterial sinusitis
- Community-acquired pneumonia (including those due to PCN-resistant ) and nosocomial pneumonia (750mg once-daily)
- Inhalational anthrax (post-exposure)
- Uncomplicated and complicated skin and soft tissue infections (750mg once-daily)
- Uncomplicated and complicated UTIs
- Bacterial conjunctivitis (Quixin 0.5% opthalmic drops);Treatment of corneal ulcer (1.5% ophthalmic solution)
- Chronic bacterial prostatitis
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
| Levaquin | Levofloxacin | JOM | oral
tablet
250mg | $12.15 |
|
|
|
| oral
tablet
500mg | $13.92 |
|
|
|
| IV
vial
500mg/20mL | $45.65 |
|
|
|
| IV
vial
750mg/30mL | $60.59 |
|
|
|
| oral
tablet
750mg | $26.08 |
|
|
|
|
| |
|
|
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|
| |
| Quixin | Levofloxacin | JOM Pharmaceutical | topical
ophthalmic solution(5ml)
0.5% | $70.00 |
| Iquix | Levofloxacin | JOMPharmaceutical | topical
ophthalmic solution (5ml)
1.5% | $70.00 |
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
- Community acquired pneumonia: 500mg IV or PO once-daily x 7-14 d
- Community acquired pneumonia: 750mg IV or PO once-daily x 5 d
- Complicated skin and skin structure infections: 750mg IV/PO once-daily x 7-14 d
- Nosocomial pneumonia: 750mg IV/PO once-daily x 7-14 d
- UTI (uncomplicated): 250mg POonce-daily x 3 d
- UTI (complicated): 250mg POonce-daily x10 d
- Chronic prostatitis: 500mg POonce-daily x 28 d
- Acute sinusitis: 500mg POonce-daily x 7-14 d (r/o viral etiology first)
- ABECB: 500mg POonce-daily x 7 d (r/o viral etiology first)
- Bacterial conjunctivitis: 0.5% ophth. solution: 1-2 gtts in affected eye q 2 hrs (up to 8 times/day) x2 days, then q 4 hrs while awake (up to 4 times/day) x 5 days.
- Corneal ulceration: 1-2 gtt (1.5%) in affected eye(s) every 30 min to 2 hrs while awake and 4 and 6 hrs at night x 3 days, then 1-2 gtts in affected eye(s) every 1-4 hrs while awake until completion.
500-750 mg once-daily
GFR 20-49 ml/min: 500-750 mg x 1, then 250mg once-daily or750mg every other day. GFR 10-19 ml/min: 500-750 mg x1, then 250-500 mg every other day.
500-750 mg, then 250-500 mg every other day; HD: dose post-HD
500-750 mg, then 250-500 mg every other day
500-750 mg, then 250-500 mg every other day
500-750 mg, then 250 mg once-daily
- GI intolerance:diarrhea
- CNS:headache, malaise, insomnia, restlessness, dizziness
- Allergic reactions
- Photosensitivity/phototoxicity (can be severe)
-
C. difficilecolitis
- Peripheral neuropathy
- Increased hepatic enzymes
- QTc prolongation (elderly patients may be more susceptible)
- Tendon rupture (Increased incidence especially seen in older patients >60, concurrent use of corticosteroids, kidney, heart, and lung transplant recipients.)
- Seizure
- Severe allergic reactions (TEN, Stevens-Johnsons syndrome, allergic pneumonitis, hepatitis, and bone marrow suppression)
- Interstitial nephritis
- Hepatitis (generally occurred within 14 days of initiation and most cases occurred within 6 days).
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NVP: no drug interactions with levofloxacin. No data with other NNRTIs but interaction unlikely.
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NFV: no drug interactions with levofloxacin. No data with other PIs but interaction unlikely.
- Divalent or trivalent cations (i.e antacids, sucralfate, buffered ddI, vitamins, and minerals): interferes with levofloxacin absorption. Do not co-administer or administer levofloxacin 2 hrs before cation.
- Avoid concurrent use with other drugs that prolong the QT interval including class Ia or class III antiarrhythmic agents, in pts with hypokalemia, significant bradycardia, or cardiomyopathy.
- Warfarin: may increase INR with co-administration. Monitor closely
- NSAIDS: may increase risk of CNS side effects (clinical significance unknown).
- PCN- resistant S. pneumoniaeto levofloxacin is low but with increase use resistance is a concern.
Levofloxacin is L-isomer of ofloxacin with good in vitro and clinical experience against S. pneumoniaeand atypical agents of pneumonia. Used primarily for lower respiratory tract infections and FDA approved for PCN-resistant S. pneumoniaeand nosocomial pneumonia. Comparable to moxifloxacin for treatment of community acquired pneumonia.
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