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Levofloxacin



Levofloxacin
Systematic (IUPAC) name
(-)-(S)-9-fluoro-2,3-dihydro-3-methyl-10-
(4-methyl-1-piperazinyl)-7-oxo-7H-pyrido
[1,2,3-de]-1,4-benzoxazine-6-carboxylic acid
Identifiers
CAS number 100986-85-4
ATC code J01MA12 S01AX19
PubChem 149096
DrugBank APRD00477
Chemical data
Formula C18H20FN3O4 
Mol. mass 361.368 g/mol
Pharmacokinetic data
Bioavailability 99%
Protein binding 24 to 38%
Metabolism Renal
Half life 6 to 8 hours
Excretion Urinary
Therapeutic considerations
Pregnancy cat.

C (United States)

Legal status

Prescription Only

Routes Oral, IV, Ophthalmic

Levofloxacin is an advanced generation fluoroquinolone antibiotic, marketed by Ortho-McNeil under the trade name Levaquin in the United States. In Europe, it is marketed by Sanofi-Aventis under the trade name Tavanic, in Chile as Gatigol by Alpes Selection, in India under the trade name Levoday marketed by Zydus Cadila and in Asia it is marketed by Daiichi under the trade name Cravit. Levofloxacin was launched in the Japanese market in 1993, and thus has had more than 13 years of testing in efficiency and safety globally. Chemically, levofloxacin is the S-enantiomer (L-isomer) of ofloxacin, and has approximately twice the potency of ofloxacin, because the R+enantiomer (D-isomer) of ofloxacin is essentially inactive. In addition, the S-enantiomer (L-isomer) of ofloxacin, has substantially less toxicity. Like other fluoroquinolines, it works by inhibiting DNA gyrase, an enzyme that negatively supercoils DNA.

Levofloxacin is effective against a number of gram-positive and gram-negative bacteria. Because of its broad spectrum of action, levofloxacin is frequently prescribed empirically for a wide range of infections (e.g. pneumonia, urinary tract infection) before the specific causal organism is known. If the causal organism is identified, levofloxacin may be discontinued and the patient may be switched to an antibiotic with a narrower spectrum of activity. Levofloxacin is currently the only respiratory fluoroquinolone approved by the U.S. FDA for the treatment of nosocomial pneumonia.

Additional recommended knowledge

Contents

Susceptible organisms

Gram-positive bacteria

  • Enterococcus faecalis (many strains are only moderately susceptible)
  • Staphylococcus aureus (methicillin-susceptible strains)
  • Staphylococcus epidermidis (methicillin-susceptible strains)
  • Staphylococcus saprophyticus
  • Streptococcus pneumoniae (including Multidrug-resistant strains, MDRSP)
  • Streptococcus pyogenes

Gram-negative bacteria

  • Enterobacter cloacae
  • Klebsiella pneumoniae
  • Pseudomonas aeruginosa
  • Escherichia coli
  • Legionella pneumophila
  • Serratia marcescens
  • Haemophilus influenzae
  • Moraxella catarrhalis
  • Haemophilus parainfluenzae
  • Proteus mirabilis
  • Campylobacter

Side Effects

This drug has similar side effects to all the other fluoroquinolone antibiotics. The most common side effects include: Nausea, stomach upset, loss of appetite, diarrhea, drowsiness, dizziness, headache, or trouble sleeping. The less common, but much more serious side effects are: Chest pain, change in the amount of urine, dark urine, easy bruising, or bleeding, fainting, fast, or irregular heartbeat, mood changes (e.g., suicidal thought or severe depression), persistent nausea, or vomiting, persistent sore throat or fever, seizures, unusual fatigue, yellowing eyes and skin, white patches in the mouth, or a change in vaginal discharge. Notify your Doctor immediately if you experience any of the more serious symptoms.

As with all fluoroquinolones there are documented cases of spontaneous tendon rupture in less than 1 in 10,000 patients who have used this drug, the dosage in these patients were the prescribed 2 500mg tablets a day, for five days. There are other cases of severe pain, and swelling in as little as two days. If you experience leg pain, or difficulty walking, then discontinue use immediately, and seek a doctor familiar with this drug. This is known as "quinolone-induced tendonopathy"

Other

  • Chlamydia pneumoniae
  • Mycoplasma pneumoniae
  • Peptostreptococcus sp.
  • More bacterial coverage is available as per prescribing information for levofloxacin in Japan

External Link

http://www.bangladesh-drug-medicine.info/2007/12/28/ovel-500/

References

http://www.jabfm.org/cgi/content/full/16/5/458 http://jac.oxfordjournals.org/cgi/content/full/51/3/747


(Cravit)

 
This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Levofloxacin". A list of authors is available in Wikipedia.
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