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Levofloxacin parenteral

Updated 2 Feb 2023 | Quinolones


Solution for infusion containing levofloxacin as levofloxacin hemihydrate.

Drugs List

  • levofloxacin 500mg/100ml intravenous infusion
  • Therapeutic Indications


    Chronic bacterial prostatitis: treatment
    Community acquired pneumonia when other treatment inappropriate
    Complicated skin and soft tissue infections: other treatment inappropriate
    Complicated urinary tract infections
    Inhalation anthrax


    It is possible to switch from initial intravenous treatment to the oral route after a few days depending on the condition of the patient. The same dosage can be used given the bioequivalence of the parenteral and oral forms.


    Community acquired pneumonia when other treatment inappropriate
    500mg once or twice daily, for 7 to 14 days.

    500mg once daily, for 7 to 10 days.

    Complicated urinary tract infections
    500mg once daily, for 7 to 14 days.

    Chronic bacterial prostatitis
    500mg once daily, for 28 days.

    Complicated skin and soft tissue infections when other treatment inappropriate
    500mg once or twice daily, for 7 to 14 days.

    Inhalation anthrax
    500mg once daily, for 8 weeks.

    Patients with Renal Impairment

    500mg every 24 hours dosing schedule
    First dose
    Subsequent doses
    Creatinine clearance 20-50 ml/minute: 250mg every 24 hours
    Creatinine clearance below 19 ml/minute: 125mg every 24 hours

    500 mg every 12 hours dosing schedule
    First dose
    Subsequent doses
    Creatinine clearance 20-50 ml/minute: 250mg every 12 hours
    Creatinine clearance below 19 ml/minute: 125mg every 12 hours


    Levofloxacin solution is administered by slow intravenous infusion. The infusion time must be at least 60 minutes for 500mg levofloxacin solution for infusion.


    Children under 18 years
    Epileptic disorder
    History of seizures
    History of tendon disorder secondary to quinolone use
    Long QT syndrome
    Myasthenia gravis
    Torsade de pointes

    Precautions and Warnings

    Family history of long QT syndrome
    Organ transplant recipients
    Patients over 60 years
    Predisposition to aortic aneurysm
    Predisposition to aortic dissection
    Predisposition to seizures
    Restricted sodium intake
    Aortic aneurysm
    Aortic dissection
    Cardiac disorder
    Diabetes mellitus
    Electrolyte imbalance
    G6PD deficiency
    History of psychiatric disorder
    History of torsade de pointes
    Renal impairment

    Correct electrolyte disorders before treatment
    May exacerbate myasthenia gravis
    Monitor for haemolysis in G6PD deficiency
    Sodium content of formulation may be significant
    Advise ability to drive/operate machinery may be affected by side effects
    Consult national/regional policy on the use of anti-infectives
    Perform ECG before and during treatment
    Consider pseudomembranous colitis if patient presents with severe diarrhoea
    Discontinue at first sign of pain/inflammation of limb(possible tendonitis)
    Discontinue treatment if patient develops seizures
    If rash develops, consider possibility of Stevens-Johnson Syndrome
    Monitor blood glucose closely in patients with diabetes mellitus
    Monitor serum electrolytes
    Reduce dose in patients with creatinine clearance below 51ml/min
    Advise patient to report any changes in vision, taste, smell or hearing
    Advise patient to report mucosal/skin reactions (blistering or peeling)
    Advise patient to report new visual problems and symptoms
    Advise patient to report signs of neuropathy
    Advise patient to report signs of tendinitis
    Advise patient to report tiredness, mood, memory or sleep disturbances
    Advise patient to rest affected limb if tendonitis occurs
    Advise patient to seek medical advice if joint aches or pain occur
    Advise patient to stop therapy & contact Dr if hypersensitivity signs occur
    Advise patients to report muscle pain/tenderness/weakness
    Advise pt. to seek medical attention if sudden abdominal,chest or back pain
    Discontinue if central nervous disturbances occur
    Discontinue if psychiatric disturbances develop
    May cause convulsions
    Patient should report worrying psychological changes esp. suicidal thoughts
    Patients over 60 years are prone to tendon inflammation
    Predisposition QT prolongation: Counsel patient on symptoms of arrhythmias
    Prolonged use may result in superinfection with non-susceptible organisms
    May affect results of some laboratory tests
    Discontinue at once if pseudomembranous colitis occurs
    Discontinue if peripheral neuropathy occurs
    Discontinue if symptoms of hepatic disease occur
    Discontinue in patients showing suicidal behaviour
    Interrupt infusion if hypotension occurs
    Avoid exposure to sunlight/UV rays during and for 2 days after treatment

    Levofloxacin is not recommended for the treatment of Methicillin-resistant S. aureus (MRSA) infection. In case of a suspected or confirmed infection due to MRSA, treatment with an appropriate antibacterial agent should be started.

    In most severe cases of pneumococcal pneumonia, levofloxacin may not be the optimal therapy. Nosocomial infections due to Pseudomonas aeruginosa may require combination therapy.

    There is an increased risk of aortic aneurysm and dissection following treatment with levofloxacin. Use levofloxacin only after careful benefit risk assessment in patients with positive family history of aneurysm disease, or in patients diagnosed with pre-existing aortic aneurysm and or aortic dissection, or in the presence of other risk factors or conditions predisposing for aneurysm and dissection (e.g. Marfan syndrome, vascular Ehlers-Danlos syndrome, Takayasu arteritis, giant cell arthritis, Behcet's disease, hypertension, known atherosclerosis.)

    Disabling, long-lasting and potentially irreversible adverse reactions mainly affecting musculoskeletal and nervous systems have been reported with quinolone and fluoroquinolone antibiotics. Treatment should be discontinued at the first signs of a serious adverse reaction such as tendinitis, pain or inflammation.

    Pregnancy and Lactation


    Levofloxacin is contraindicated during pregnancy.

    At the time of writing there is limited published information regarding the use of levofloxacin during pregnancy. The manufacturer contraindicates the use of levofloxacin in pregnancy, citing the potential for damage to the weight-bearing cartilage of the foetus.

    Reproductive studies in animals did not indicate reproductive toxicity.

    Levofloxacin is known to cross the placenta, and is found in the amniotic fluid at low concentrations.

    Schaefer advises that quinolones should only be used during pregnancy in cases of complicated infections resistant to the antibiotics of choice. In these occasions, Schaefer recommends the use better studied quinolones such as norfloxacin or ciprofloxacin. The use of a quinolone antibiotic is not grounds for termination of pregnancy but a detailed foetal ultrasonograph may be considered.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Levofloxacin is contraindicated in breastfeeding.

    It is not known if levofloxacin is secreted in breast milk, but due to the secretion of similar fluoroquinolones in breast milk and the theoretical risk of damage to the weight-bearing cartilage of the foetus, use of levofloxacin in breastfeeding mothers is contraindicated by the manufacturer.

    Schaefer recommends the use of standard antibiotic with a lower potential for risk over the use of levofloxacin in breastfeeding. However, when a complicated infection necessitates the use of quinolones, ciprofloxacin may be preferable.

    LactMed suggests that the amount of the drug secreted in breast milk is low, and is unlikely to harm the breastfed infant. To limit exposure of the infant to levofloxacin, LactMed recommends delaying breastfeeding until 4 to 6 hours after each dose.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Abdominal pain
    Acute hepatic failure
    Acute renal failure
    Aggravation of porphyria
    Anaphylactoid reaction
    Antibiotic-associated colitis
    Benign raised intracranial pressure
    Diarrhoea - bloody
    Erythema multiforme
    Exacerbation of myasthenia gravis
    Extrapyramidal effects
    Fungal superinfection
    Haemolytic anaemia
    Hearing disturbances
    Hepatic impairment
    Hypersensitivity reactions
    Increases in hepatic enzymes
    Injection site reactions
    Interstitial nephritis
    Muscle weakness
    Peripheral neuropathy
    Prolongation of QT interval
    Pseudomembranous colitis
    Psychotic reactions
    Serum bilirubin increased
    Serum creatinine increased
    Sleep disturbances
    Smelling disturbances
    Stevens-Johnson syndrome
    Suicidal tendencies
    Taste disturbances
    Tendon disorder
    Tendon rupture
    Toxic epidermal necrolysis
    Vasculitis (allergic)
    Visual disturbances

    Effects on Laboratory Tests

    In patients treated with levofloxacin, determination of opiates in urine may give false-positive results. It may be necessary to confirm positive opiate screens by more specific methods.

    Levofloxacin may inhibit growth of Mycobacterium tuberculosis and, may give false-negative results in the bacteriological diagnosis of tuberculosis.


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: September 2018

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Summary of Product Characteristics: Levofloxacin 500mg/100ml Solution for Infusion Vials. Bowmed Ibisqus Limited. Revised October 2015.
    Summary of Product Characteristics: Levofloxacin 500mg/100ml Solution for Infusion Vials. Peckforton Pharmaceuticals Ltd. Revised July 2014.

    MHRA Drug Safety Update March 2019
    Available at:
    Last accessed: 20 May 2019

    NICE Evidence Services Available at: Last accessed: 24 September 2018

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Levofloxacin. Last revised: 08 August, 2017
    Last accessed: 24 September, 2018

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