Dosing
CrCl > 80: 750 - 500 mg po/iv q 24 h.
CrCl 80-50:
CrCl 50-10: 250 mg iv/po q 24 h.
CrCl < 10: 250 mg iv/po q 48 h.
Hemodialysis:
Peritoneal dialysis:
Important side effects
Maybe the quinolone most likely to cause tendinopathy (Pubmed).
Decreased or blurred vision (ophthalmic solution), diarrhea, headache, hyperglycemia, hypoglycemia (usually in diabetic patients), injection site reactions, nausea, peripheral neuropathy, severe hypersensitivity reactions (rare), tendon rupture (rare), torsades de pointes (rare). Diplopia (PubMed).
Maybe retinal detachment (PubMed). Or not (PubMed). Probably for rhegmatogenous retinal detachment (PubMed).
Liver disease in the elderly (about 6 in 100,000) (PubMed).
It can double the risk of acute kidney injury (PubMed).
Arrhythmias: "Gatifloxacin use was associated with the highest rate (RR = 7.38; 95% CI, 2.30-23.70); moxifloxacin and ciprofloxacin were also associated with elevated rates of serious arrhythmia (RR = 3.30; 95% CI, 1.47-7.37 and RR = 2.15; 95% CI, 1.34-3.46, respectively)" (PubMed). Not so much with levofloxacin.
Important drug interactions
As with all quinolones, oral divalent cations will bind the drug and prevent absorption. aluminum carbonate, basic, aluminum hydroxide, aluminum phosphate, antidiabetic agents, calcium, class ia antiarrhythmic agents, class iii antiarrhythmic agents, corticosteroids, didanosine, dihydroxyaluminum aminoacetate, dihydroxyaluminum sodium carbonate, iron, magaldrate, magnesium carbonate, magnesium hydroxide, magnesium oxide, magnesium trisilicate, mesoridazine, nonsteroidal anti-inflammatory agents, phenothiazines, sucralfate, theophylline, thioridazine, typhoid vaccine, warfarin, zinc, ziprasidone.
Rants and Screeds
Pearls
As with all quinolones, oral divalent cations will bind the drug and prevent absorption.
Treatment of choice
Use for
Anthrax - postexposure prophylaxis, Cellulitis, Bronchitis-chronic, Conjunctivitis, corneal ulcer, enteritis, gynecological infections, Diarrhea, meningitis - tuberculous, Otitis media, Pneumonia, Prostatitis, Sexually Transmitted Diseases, Sinusitis, surgical infections, Tuberculosis, UTI.
Don't use for
For me, Pseudomonas and I do not trust it for streptococci or staphylococci. But that's me. Sometime in 2005, the IDSA had a supplement about promoting levofloxacin and Pseudomonas; are they in the pockets of the drug companies or what? It is so depressing. www.nofreelunch.org.
Class
Quinolone.
Curious Cases
Relevant links to my Medscape blog
Last update 11/28/19