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Levofloxacin (Levaquin): Compare to Other Antibiotics

Generic Name: Levofloxacin

Under what local brands and in what dosages is generic Levofloxacin sold in pharmacies of Britain, United States, and Canada?

In pharmacies of the United States, Great Britain and Canada the pharmacists offer you to buy Levofloxacin according to your prescription or without a prescription under such brand names and in such strengths and dosage forms:

UK US Canada
Evoxil 250mg film-coated tablets

Evoxil 500mg film-coated tablets

Evoxil 5mg/ml solution for infusion

Levofloxacin 250mg Tablets

Levofloxacin 500mg Tablets

Levofloxacin 5mg/ml Solution for Infusion

Tavanic I.V. 5 mg/ml

Tavanic 250 mg Tablets

Tavanic 500 mg Tablets

Levaquin 250 mg Tablets

Levaquin 500 mg Tablets

Levaquin 750 mg Tablets

Levaquin Solution 250mg/10ml

Levaquin Injectable 500mg/20ml

Levaquin Injectable 750mg/30ml

Levofloxacin 250 mg Tablets

Levofloxacin 500 mg Tablets

Levofloxacin 750 mg Tablets

Levaquin 250 mg Tablets

Levaquin 500 mg Tablets

Levaquin 750 mg Tablets

Novo-Levofloxacin 250 mg Tablets

Mylan-Levofloxacin 500 mg Tablets

Apo-Levofloxacin 750 mg Tablets

Levofloxacin Solution 250mg/10ml

Levofloxacin Injectable 500mg/20ml

Levofloxacin Injectable 750mg/30ml

Fluoroquinolone antibiotics such as ciprofloxacin (Cipro), norfloxacin (Noroxin) and ofloxacin (Floxin) are commonly prescribed due to their broad spectrum of antimicrobial activity and relatively safe adverse effect profile. A new antibiotic recently launched by Ortho-McNeil Pharmaceuticals, levofloxacin (Levaquin), is related to the currently available antibiotic ofloxacin.

Ofloxacin is composed of two isomers, known as levo and dextro isomers. Levofloxacin is the optically active levo isomer responsible for antibacterial effects. Its pharmacokinetic properties allow it to be dosed once daily, as opposed to ofloxacin, which is given twice a day. Also, levofloxacin is a solitary isomer; therefore, it is associated with fewer side effects compared to ofloxacin. The Food and Drug Administration (FDA) has approved levofloxacin for the treatment of community-acquired pneumonia, acute exacerbation of chronic bronchitis, sinusitis, uncomplicated skin and skin structure infections (SSI), urinary tract infections (UTI) and pyelonephritis. Other studies have investigated levofloxacin’s use in Legionnaires’ disease, leprosy, infections of the female reproductive tract and tuberculosis.

Similar to other fluoroquinolones, levofloxacin is rapidly bactericidal with a broad spectrum of activity. It is a synthetic compound available for oral (po) or intravenous (IV) administration. Levofloxacin causes bacterial cell death by inhibiting the A subunits of deoxyribonucleic acid (DNA) gyrase (bacterial topoisomerase II), which inhibits bacterial DNA replication, transcription, repair and recombination. It is active against a wide range of aerobic gram-negative and gram-positive aerobes, and microorganisms such as C. pneumoniae and M. pneumoniae. Although most quinolones possess weak activity against anaerobes, levofloxacin appears to have moderate anaerobic activity. One in vitro study of levofloxacin by Une et al. demonstrated the highest level of antimicrobial activity against B. fragilis and Peptococcus spp. when compared to ofloxacin, ciprofloxacin, fleroxacin and NY-198.

Levofloxacin (Levaquin) is indicated for sinusitis due to S. pneumoniae, H. influenzae or M. catarrhalis. It is also indicated for bronchitis due to S. aureus, S. pneumoniae, H. influenzae, H. parainfluenzae or M. catarrhalis. Levofloxacin eradicates several pneumonia pathogens, which include the aforementioned organisms in addition to K. pneumoniae, C. pneumoniae, L. pneumophila, or M. pneumoniae.

Levofloxacin can also treat uncomplicated skin infections caused by S. aureus or S. pyogenes. Finally, levofloxacin can be administered to patients with urinary tract infections and pyelonephritis caused by E. faecalis, E. cloacae, E. coli, K. pneumoniae, P. mirabilis or Pseudomonas aeruginosa. Levofloxacin is not active against methicillin-resistant staphylococci, including S. aureus, S. epidermidis and S. haemolyticus. In addition, although P. aeruginosa appears to be more susceptible to levofloxacin than other fluoroquinolones, resistant strains are a persistent problem. Resistance to levofloxacin appears to be chromosomally mediated; changes in the A or B subunits of DNA gyrase can help confer bacterial resistance to levofloxacin.

Levofloxacin (Levaquin): Pharmacokinetics

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Oral doses of levofloxacin are rapidly and completely absorbed. The absolute bioavailability of a 500 mg dose is 99%. Levofloxacin has a linear pharmacokinetic profile with peak plasma concentrations achieved within one to two hours after oral dosing. When levofloxacin is administered with food, only a slight decrease in peak plasma concentration (Cpmax) and time to peak serum concentration (tmax) occurs; therefore, it can be administered without regard to food. When equal doses of oral levofloxacin and intravenous (IV) levofloxacin are administered (mg per mg), the area under the serum concentration-time curve (AUC) of IV levofloxacin is comparable to oral levofloxacin; therefore, the oral and IV routes are interchangeable. Levofloxacin’s volume of distribution (Vd) is very large. It is widely distributed into many tissues and body fluids, including the lungs and blister fluid. Child et al. examined the penetration of levofloxacin into inflammatory exudate, and found once or twice daily administration of levofloxacin attained concentrations in inflammatory fluid and plasma necessary to eliminate a majority of pathogens that cause common infections. Levofloxacin undergoes limited metabolism, and the majority is excreted in the urine as unchanged drug via glomerular filtration and tubular secretion. The long serum elimination half-life of levofloxacin (6 hours) allows for once-daily dosing. Levofloxacin is not hemodialyzable and, therefore, supplemental doses are not required following hemodialysis or continuous ambulatory peritoneal dialysis (CAPD).

Clinical Trials

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Levofloxacin was developed in Japan, and a myriad of large clinical studies are available evaluating its efficacy in the Japanese population. Studies completed in the United States are limited; however, levofloxacin (Levaquin) is being actively investigated.

Respiratory Infections

Sato et al. published a trial evaluating the efficacy of levofloxacin in 87 elderly patients with acute respiratory tract infections, or as secondary infections in immunocompromised patients. The most common diagnoses were acute bronchitis, pneumonia and secondary infection of chronic respiratory conditions. The majority (58) of the patients were treated as outpatients, while the remaining patients (29) were treated as inpatients.

The average age of the study population was 69.9 years. Organisms isolated prior to the study included S. aureus, a-Streptococcus, S. pneumoniae, H. influenzae, Pseudomonas spp., Neisseria spp. and Candida. The outpatients received levofloxacin 100 mg po three times/day for three days, and inpatients received 200 mg po three times/day for seven days. Efficacy was evaluated twice for hospitalized patients (day 3 and 7) and once for the outpatients (day 3), and determined by x-rays, levels of C-reactive proteins, and symptoms. After evaluating clinical efficacy compared to dosage regimen, 83% of the patients who received 300 mg/day improved by day 3, and 100% of the patients receiving 600 mg/day improved by day 3.

Approximately 80% of the pathogens were eradicated by the end of the study. However, the bacteria of three patients were eventually replaced by another organism. Levofloxacin (Levaquin) was tolerated extremely well; only one patient reported epigastric discomfort. The authors concluded that it was safe to use in the elderly, and useful in the early stages of respiratory infection.

Skin Infections

Levofloxacin (Levaquin) is indicated for the treatment of uncomplicated skin infections caused by S. aureus and S. pyogenes. Two large clinical trials in Japan demonstrated levofloxacin’s effects against various skin pathogens, the majority of which were methicillin-sensitive S. aureus or coagulase-negative staphylococci. A total of 643 patients received levofloxacin 100 mg po three times/day for three days for various SSI. Levofloxacin was associated with a bacterial eradication rate of 90%. Several in vitro studies have confirmed these organisms are susceptible to levofloxacin.

Goldstein et al. published a prospective study investigating the activity of 10 oral antibiotic agents against bacteria isolated from diabetic foot infections. The foot wounds of 25 consecutive patients either were swabbed or pus was aspirated to find the causative pathogen. Bacteria isolated included S. aureus, streptococci, enterococci, Enterobacteriaceae, P. mirabilis, E. coli, Klebsiella spp., B. fragilis and Peptostreptococci. Staphylococcus was the most common pathogen (76%), followed by enterococci, Enterobacteriaceae and anaerobes (all >40%). Bacteria were cultured, and the isolates were stored and tested for susceptibility to the following antimicrobial agents: sparfloxacin, levofloxacin, ofloxacin, ciprofloxacin, amoxicillin/clavulanic acid, cephalexin, cefuroxime, cefprozil, loracarbef, doxycycline and clindamycin. Data were collected, and the minimum inhibitory concentrations (MICs) were determined. Sparfloxacin and levofloxacin were the most active antibacterial agents, displaying activity against 88% of the bacteria. Levofloxacin (Levaquin) did not possess any antibacterial activity against MRSA, enterococci, and a few anaerobes.

Urinary Tract Infections (UTIs) / Pyelonephritis

Organisms responsible for causing genitourinary problems, such as E. coli, E. faecalis, K. pneumoniae, and P. aeruginosa, are for the most part susceptible to levofloxacin therapy. Japanese studies have demonstrated that efficacy rates range from 86% to 100% in the treatment of UTIs when levofloxacin is administered as 100 to 600 mg/day. In another foreign study, N. gonorrhoeae and C. trachomatis were completely eliminated in patients with urethritis by administering 200 to 400 mg/day levofloxacin for 3–14 days. Several in vitro studies published in the United States have confirmed the susceptibility of genitourinary pathogens to levofloxacin.

Infections of the Female Reproductive Tract

Levofloxacin (Levaquin) is not indicated for gynecologic infections; however, studies evaluating its effectiveness in such infections are being pursued. In Japan, levofloxacin has been used to treat infections of the female reproductive tract, such as intrauterine infection and mastitis. In one clinical trial, 197 women with gynecological infections were administered levofloxacin 200–300 mg po every day for 3–14 days. The most frequently isolated pathogen was C. trachomatis. Other common pathogens were E. coli, S. aureus, Streptococcus spp. and Peptostreptococcus spp. The observed eradication rate for C. trachomatis was 93%, while all other organisms displayed eradication rates greater than 95%.

Madinger et al. published a study evaluating the role of several antibiotics in the treatment of gynecological infections. One hundred ninety-one bacterial isolates (some anaerobes) were obtained from women with upper reproductive tract infections. The isolates were then cultured and tested for susceptibility to antibiotics, including amoxicillin/clavulanate, ampicillin, clindamycin, metronidazole, doxycycline, cefoxitin, cefixime, cefpodoxime proxetil, ofloxacin, and levofloxacin. Clindamycin, amoxicillin/clavulanate, and cefoxitin were the most active agents, with eradication rates as high as 95%. However, levofloxacin displayed “good” activity against several anaerobic pathogens isolated in this study; its activity was “compared favorably with that of metronidazole.” Due to the anaerobic activity reported in this study, the authors suggested that levofloxacin (Levaquin) may someday be used to treat gynecologic infections.

Levofloxacin (Levaquin): Adverse Effects

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Clinical trials have demonstrated that oral levofloxacin is generally well tolerated. Consistent with other fluoroquinolone antibiotics, gastrointestinal and central nervous system effects are reported most frequently. Less commonly reported adverse effects include dizziness, vomiting, abdominal pain, dyspepsia, rash, vaginitis, flatulence, pruritus, and chest and back pain. The most common adverse effects of IV levofloxacin include nausea (6.6.%), injection site reaction (5.6%), diarrhea (5.4%), headache (5.4%) and constipation (3.1%). High dosages of levofloxacin have been shown to cause articular damage in study animals. Phototoxic reactions are rare.

Drug Interactions and Warnings

When you buy cheap Levaquin you must know how to use it

Shiba et al. examined the effects of various drugs on absorption of oral levofloxacin (Levaquin). Concurrent use of levofloxacin with aluminum or magnesium antacids or ferrous sulfate decreased the bioavailability of levofloxacin by inhibiting absorption. Ranitidine showed no effect on levofloxacin’s bioavailability. Other drugs that may decrease bioavailability include sucralfate and multivitamins with zinc. Drugs that affect the bioavailability of levofloxacin should be taken two hours before or two hours after levofloxacin administration.

Other quinolones, e.g., ciprofloxacin, are potent inhibitors of cytochrome P450 and can increase plasma concentrations of theophylline. Levofloxacin is not extensively metabolized in the liver and does not significantly affect plasma concentrations of drugs metabolized by cytochrome P450.

Potential pharmacokinetic drug interactions have been evaluated with warfarin, cyclosporine, digoxin, probenecid and cimetidine; no clinically significant drug/drug interactions were documented. However, caution must be used when quinolones are administered with NSAIDs or antidiabetic agents. Quinolones administered in combination with NSAIDs have the potential to increase CNS stimulation or the risk of convulsive seizures. Also, there have been reports of blood glucose disturbances (hypo- and hyperglycemia) in patients treated concomitantly with quinolones and antidiabetic agents. Diabetics taking levofloxacin should closely monitor their blood glucose concentrations.

Levofloxacin (Levaquin) is contraindicated in patients with known hypersensitivity to any component of the drug or to other quinolones. The safety and efficacy of levofloxacin in children less than 18 years of age, pregnant women, and nursing mothers has not been established. Only transient arthropathies in children who have received fluoroquinolones have been observed; however, these agents should be avoided in children. Levofloxacin has a pregnancy category C rating and should be used only if the potential benefit outweighs the potential risk.

In clinical trials, phototoxicity was observed in less than 0.1% of patients. However, patients should be warned to avoid excessive sunlight or artificial ultraviolet light. Severe phototoxic reactions have been observed in patients exposed to sunlight while taking other fluoroquinolones.

Levaquin: Dosage and Administration

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A normal dose of Levaquin (levofloxacin) is 500 mg po q 24h, or 500 mg IV q 24h (administered over at least 60 minutes). However, the duration of treatment and daily dose may vary depending on the indication. Acute exacerbations of chronic bronchitis require 500 mg po q 24h x 7 days. Community-acquired pneumonia requires 500 mg/day for 7–14 days. Acute maxillary sinusitis requires 500 mg/day for 10–14 days. A dose of 500 mg/day for 7–10 days is given for uncomplicated SSI and 250 mg/day for 10 days is the course of treatment for complicated UTI and acute pyelonephritis. Oral doses should be taken at least two hours before or two hours after antacids, sucralfate, iron preparations or multivitamins containing zinc. After an initial dose of 500 mg, dosage adjustments should be made for varying degrees of renal impairment: creatinine clearance (CrCl) 29–40 mL/min, 250 mg q 24h; CrCl 10–19 mL/min, 250 mg q 48h; hemodialysis and CAPD patients, 250 mg q 48h. For patients being treated for urinary tract infections or pyelonephritis with CrCl 10–19 mL/min, 250 mg q 48h. No dosage adjustments are necessary for patients with impairment of liver function.


The safety and effectiveness of Levaquin (levofloxacin) in children less than 18 years old are yet to be established.


No dosage adjustments are necessary in elderly patients unless CrCl is <50 mL/min.


Levaquin (levofloxacin) tablets are available in two strengths, 250 mg and 500 mg. Levofloxacin IV is available as single-use injection vials (20 mL) containing 500 mg of levofloxacin, or premixed flexible containers containing either 250 mg or 500 mg levofloxacin in 5% Dextrose solution (D5W).

Admixture Compatibility

Solutions compatible with levofloxacin IV include 0.9% Sodium Chloride Injection, 5% Dextrose Injection, 5% Dextrose/0.9% Sodium Chloride Injection, 5% Dextrose in Lactated Ringers, Plasma-Lyte 56/5% Dextrose Injection, 5% Dextrose/0.45% Sodium Chloride, 0.15% Potassium Chloride Injection, and Sodium Lactate Injection (M/6).

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