Levofloxacin Φαρματεν (Levofloxacin Hemihydrate)

• Levofloxacin is a broad‑spectrum fluoroquinolone used to treat bacterial infections in several organ systems.
• Community‑acquired pneumonia: achieves rapid bacterial eradication and clinical recovery.
• Urinary tract infections: clears uropathogens causing cystitis and pyelonephritis.
• Skin and soft‑tissue infections: resolves cellulitis and wound infections.
• Sinusitis: eliminates causative bacteria and relieves sinus inflammation.
• Bronchitis: reduces bacterial load in acute exacerbations.
• Complicated intra‑abdominal infections: provides coverage for mixed aerobic and anaerobic organisms.

• Levofloxacin inhibits bacterial DNA gyrase (topoisomerase II) and topoisomerase IV, enzymes essential for DNA replication, transcription, and repair. By stabilizing the DNA‑enzyme complex, it prevents the resealing of DNA strands, leading to bacterial cell death and a bactericidal effect against susceptible organisms.

Levofloxacin may cause a range of adverse reactions, from mild to severe.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Diarrhea: loose stools, occasionally watery.
• Headache: transient cranial discomfort.
• Dizziness: occasional vertiginous sensation.
• Rash: mild skin erythema or pruritus.
• Elevated liver enzymes: transient hepatic enzyme rise.

Serious or Rare Side Effects

• Tendon rupture: especially Achilles, may occur during or after therapy.
• QT interval prolongation: risk of cardiac arrhythmias.
• Severe allergic reactions: anaphylaxis, angioedema.
• Clostridioides difficile colitis: severe diarrhea due to gut flora disruption.
• Peripheral neuropathy: sensory deficits, tingling.
• Stevens‑Johnson syndrome/toxic epidermal necrolysis: life‑threatening skin reactions.

Levofloxacin requires careful consideration of patient‑specific factors before use.

• Renal impairment: dose adjustment may be needed to avoid accumulation.
• History of tendon disorders: avoid use due to increased rupture risk.
• QT prolongation risk: monitor ECG in patients with cardiac disease or electrolyte abnormalities.
• Pregnancy Category C: prescribe only if benefits outweigh potential fetal risk.
• Store at room temperature: keep in original container, protect from light and moisture.

Levofloxacin can interact with several medicines, altering efficacy or safety.

Major Interactions (Avoid)

• Tizanidine: may cause severe hypotension and sedation.
• Warfarin: increased anticoagulant effect, monitor INR closely.
• Concurrent fluoroquinolones: additive toxicity, avoid combination.

Moderate Interactions (Monitor Closely)

• Antacids, iron supplements, or sucralfate: reduce levofloxacin absorption.
• Corticosteroids: heightened risk of tendon rupture.
• Diuretics (e.g., furosemide): may exacerbate QT prolongation.
• CYP1A2 inhibitors (e.g., ciprofloxacin): modest increase in levofloxacin levels.