Johns Hopkins POC-IT: Point of Care Information Technology [Home]
HIV Guide
 Zambia HIV National Guidelines
 


Introduction  

HIV Counseling and Testing  

Sexually Transmitted Infections (STIs)  

General Principles of Antiretroviral Therapy for Chronic HIV Infection in Adults and Adolescents  

When to Start ARV Therapy for Chronic HIV Infection in Adults and Adolescents  

Initial Regimen for ARV Therapy  

Adherence  

Baseline evaluation and Monitoring  

Calculations: Ideal Body Weight, Body Mass Index and Creatinine Clearance  

ARV Therapy for Individuals with Tuberculosis Co-Infection  

Adverse Effects and Toxicity  

Immune Reconstitution Inflammatory Syndrome (IRIS)  

Changing or Stopping ART  

Treatment Failure  

Stopping ARV Therapy  

Post Exposure Prophylaxis  

Cotrimoxazole Prophylaxis  

WHO Staging in Adults and Adolescents  

Nutrition Care and Support  

Palliative Care in HIV and AIDS  

 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Drugs>Antimicrobial Agents>
HIV Guide Home PageEmail this module to a friend

Levofloxacin

Paul A. Pham, Pharm.D. and John G. Bartlett, M.D.
09-01-2009

Zambia Specific Information

  • 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.

INDICATIONS

FDA

  • 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

FORMS

brand 
name
 
generic 
Mfg 
brand 
forms
 
cost* 
Levaquin Levofloxacin JOMoral
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
     

     

QuixinLevofloxacinJOM Pharmaceuticaltopical
ophthalmic solution(5ml)
0.5%
$70.00
IquixLevofloxacin 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.

USUAL ADULT DOSING

  • 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.

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

500-750 mg once-daily

DOSING FOR GLOMERULAR FILTRATION OF 10-50

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.

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

500-750 mg, then 250-500 mg every other day; HD: dose post-HD

DOSING IN HEMODIALYSIS

500-750 mg, then 250-500 mg every other day

DOSING IN PERITONEAL DIALYSIS

500-750 mg, then 250-500 mg every other day

DOSING IN HEMOFILTRATION

500-750 mg, then 250 mg once-daily

ADVERSE DRUG REACTIONS

GENERAL

  • Generally well tolerated
OCCASIONAL

  • GI intolerance:diarrhea
  • CNS:headache, malaise, insomnia, restlessness, dizziness
  • Allergic reactions
  • Photosensitivity/phototoxicity (can be severe)
  • C. difficilecolitis
RARE

  • 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).

DRUG INTERACTIONS

  • NVP: no drug interactions with levofloxacin. No data with other NNRTIs but interaction unlikely.
  • 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).

SPECTRUM

Detailed Spectrum of Activity

RESISTANCE

  • PCN- resistant S. pneumoniaeto levofloxacin is low but with increase use resistance is a concern.

PHARMACOLOGY

Pharmacology

COMMENTS

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.

REFERENCES

REFERENCED WITHIN THIS GUIDE


 
Diagnosis
 


Complications of Therapy


Malignancies


Miscellaneous


Opportunistic Infections


Organ System

Drugs
 


Antimicrobial Agents


Antiretrovirals


Miscellaneous

Guidelines
 


Zambia HIV National Guidelines

Management
 


Antiretroviral Therapy


Laboratory Testing


Miscellaneous

Pathogens
 


Bacteria


Fungi


Parasites


Viruses

View All Modules
 
Index
 
 
Contacts    Help    Copyright    Acknowledgments    Abbreviations