Levofloxacin

What it is

Levofloxacin is the active enantiomer of ofloxacin, a third-generation fluoroquinolone with a balanced spectrum: it covers Gram-negatives well and, unlike ciprofloxacin, also Gram-positives (pneumococcus) and atypical bacteria (Mycoplasma, Legionella, Chlamydia).

It is used in community-acquired pneumonia, some COPD exacerbations, prostatitis and some urinary infections. It shares the European restrictions of 2018–2019 with the other fluoroquinolones: it is not used for mild infections or when another antibiotic is appropriate, because of the risk of serious effects on tendons, nerves and the aorta.

Mechanism of action

It inhibits:

• DNA gyrase and topoisomerase IV (bacterial DNA synthesis and replication)
• Balanced cover: Gram-negative, Gram-positive and atypical bacteria
• A bactericidal effect (it actively kills bacteria)

At the counter

When to recommend it

• Community-acquired pneumonia when the doctor considers a quinolone necessary
• COPD exacerbation with a bacterial cause, if other antibiotics are not appropriate
• Bacterial prostatitis
• Complicated urinary infections, according to the culture result

When not to

• Allergy to fluoroquinolones
• History of tendinitis or tendon rupture
• Pre-existing peripheral neuropathy
• Under 18s without a clear justification

Warnings

• Important Tendinitis / tendon rupture: the same risk as ciprofloxacin. Avoid over 60 with corticosteroids.
• Important Peripheral neuropathy: rare but potentially irreversible.
• Caution Photosensitivity: less than with other fluoroquinolones, but present. Full sun protection.
• Caution Interactions: it prolongs the QT interval; caution with antiarrhythmics and other medicines that prolong it.