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What is this medication?

Antibiotic; Respiratory Fluoroquinolone

Levofloxacin is used on or off label for various infections depending on your common local bacterial strains for various infections and based on local resistance patterns.  Not all antibiotics work for all infections and efficacy can vary from area to area and vary with time.  It is common in North America for various respiratory infection hence the classification of respiratory fluoroquinolone.

Serious adverse reactions:
Fluoroquinolones have been associated with disabling and potentially irreversible serious adverse reactions that have occurred together, including tendinitis and tendon rupture, peripheral neuropathy, and CNS effects. Discontinue levofloxacin immediately and avoid the use of fluoroquinolones in patients who experience any of these serious adverse reactions. Because fluoroquinolones have been associated with serious adverse reactions, reserve levofloxacin for use in patients who have no alternative treatment options for the following indications: uncomplicated urinary tract infection, acute bacterial exacerbation of chronic bronchitis, and acute bacterial sinusitis.

Exacerbation of myasthenia gravis:
Fluoroquinolones may exacerbate muscle weakness in patients with myasthenia gravis. Avoid levofloxacin in patients with a known history of myasthenia gravis.

How does this medication work? 

Levofloxacin the S(-) enantiomer of ofloxacin, inhibits DNA gyrase in susceptible bacteria which is important in protein synthesis.  Blocking this inhibits relaxation of supercoiled DNA so it cannot be used for protein synthesis and promotes the breakage of double stranded DNA eventually causing cell death.  Humans do not have DNA gyrase which makes it an ideal target for antibiotics.

How should I take this medication? 

Oral: Take 500-750mg once a day.

How to Take: Follow instructions provided by physician/pharmacy label, take consistently at same times each day unless otherwise directed, with or without food.

You Need to Avoid: Avoid use of antacids, multivitamins or any other sources of magnesium, aluminum, iron, or zinc.  If they are required, then take levofloxacin 2 hours before or after these products as they will decrease absorption.

What should I watch for while using this medication? 

Before starting Levofloxacin, make sure your physician is aware of any allergies or medications you currently take, if you have myasthenia gravis, a history of tedinopathy/tendon rupture from quinolone use, renal impairment, rheumatoid arthritis, or if you are pregnant, or breastfeeding.  Levofloxacin use has been associated with rare but serious adverse events such as QT prolongation, aortic aneurysm/dissection, altered glucose regulation, hepatotoxicity, hypersensitivity reactions, phototoxicity, tendinopathy/rupture, peripheral neuropathy, CNS effects, psychiatric reactions, and antibiotic resistant secondary infections.

What if I miss a dose?

If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.

How should I store this medication?

Keep out of the reach of children at all times. Store at room temperature, 59 to 86° F (15 to 30° C). Protect from light. Keep the container tightly closed. Properly dispose of any unused medication after the expiration date.

What are the possible side effects of using this medication?

Dizziness, headache, insomnia, abdominal pain, constipation, diarrhea, dyspepsia, nausea, and vomiting.

Levofloxacin is generally very well tolerated except in children and should be avoided in them due to risk of musculoskeletal effects unless no other options exist.  Rates of side effects in adults are quite low (under 10% risk for all) however their use needs to be limited to rare but serious irreversible side effects that may occur.