I. See Also

II. Precautions

  1. QT Prolongation with Levofloxacin (Levaquin)
    1. Three fold increased risk of Sudden Cardiac Death while on Levofloxacin
    2. This appears to be a class effect with most Fluoroquinolones except Ciprofloxacin
    3. Ray (2013) N Engl J Med 366(20): 1881-90 [PubMed]

III. Activity Spectrum

  1. Gram Negative Rod coverage (see other Fluoroquinolones)
    1. Enterobacteriaceae
  2. Atypical bacteria
  3. Moderate Gram Positive activity

IV. Indications

  1. Community acquired Pneumonia
  2. Refractory acute bacterial Sinusitis (third line agent)

V. Preparations

  1. Levofloxacin (Levaquin)
  2. Moxifloxacin (Avelox)
    1. Low urine concentrations (avoid in UTI)
    2. No pseudomonas coverage
    3. Highest risk Quinolone for QT Prolongation
  3. Sparfloxacin (Zagam)
    1. Low urine concentrations (avoid in UTI)
  4. Gatifloxacin (Tequin)
    1. Removed from U.S. market in 2006 due to fatalities (Hypoglycemia related)

VI. Adverse Effects

  1. See Fluoroquinolone
  2. Hypoglycemia with Gatifloxacin (Tequin)
    1. Has occurred in non-diabetics
    2. Contraindicated in Diabetes Mellitus

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Cost: Medications

levofloxacin (on 1/21/2015 at Medicaid.Gov Survey of pharmacy drug pricing)
LEVOFLOXACIN 0.5% EYE DROPS Generic $8.17 per ml
LEVOFLOXACIN 25 MG/ML SOLUTION Generic $0.97 per ml
LEVOFLOXACIN 250 MG TABLET Generic $0.21 each
LEVOFLOXACIN 500 MG TABLET Generic $0.24 each
LEVOFLOXACIN 750 MG TABLET Generic $0.50 each
levaquin (on 1/6/2015 at Medicaid.Gov Survey of pharmacy drug pricing)
LEVAQUIN 250 MG TABLET Generic $0.21 each
LEVAQUIN 500 MG TABLET Generic $0.24 each
LEVAQUIN 750 MG TABLET Generic $0.50 each
gatifloxacin (on 1/21/2015 at Medicaid.Gov Survey of pharmacy drug pricing)
GATIFLOXACIN 0.5% EYE DROPS Generic $38.63 per ml
moxifloxacin (on 1/21/2015 at Medicaid.Gov Survey of pharmacy drug pricing)
MOXIFLOXACIN HCL 400 MG TABLET Generic $11.77 each
avelox (on 1/6/2015 at Medicaid.Gov Survey of pharmacy drug pricing)
AVELOX 400 MG TABLET Generic $11.77 each
AVELOX ABC PACK 400 MG TAB Generic $11.77 each

Ontology: sparfloxacin (C0052585)

Definition (NCI) A fluoroquinolone antibiotic that inhibits bacterial DNA gyrase, thereby inhibiting DNA replication and transcription. Sparfloxacin was withdrawn from the U.S. market due to a high incidence of phototoxicity.
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH C061363
SnomedCT 387554008, 96090000
LNC LP17280-6, MTHU009179
English sparfloxacin, sparfloxacin (medication), sparfloxacin [Chemical/Ingredient], 5-amino-1-cyclopropyl-7-[(3R,5S)3,5-dimethylpiperazin-1-yl]-6,8-difluoro-4-oxo-quinoline-3-carboxylic acid, 5-amino-1-cyclopropyl-7-(cis-3,5-dimethyl-1-piperazinyl)- 6,8-difluoro-1,4-dihydro-4-oxo-3-quinolinecarboxylic acid, Sparfloxacin, Sparfloxacin (product), Sparfloxacin (substance), SPARFLOXACIN
Spanish esparfloxacino, esparfloxacina (producto), esparfloxacino (producto), esparfloxacina, esparfloxacino (sustancia), esparfloxacina (sustancia)

Ontology: Levofloxacin (C0282386)

Definition (MSH) The L-isomer of Ofloxacin.
Definition (NCI) A broad-spectrum, third-generation fluoroquinolone antibiotic and optically active L-isomer of ofloxacin with antibacterial activity. Levofloxacin diffuses through the bacterial cell wall and acts by inhibiting DNA gyrase (bacterial topoisomerase II), an enzyme required for DNA replication, RNA transcription, and repair of bacterial DNA. Inhibition of DNA gyrase activity leads to blockage of bacterial cell growth.
Definition (NCI_NCI-GLOSS) A substance used to treat bacterial infections. It belongs to the family of drugs called quinolone antibiotics.
Definition (PDQ) A broad-spectrum, third-generation fluoroquinolone antibiotic and optically active L-isomer of ofloxacin with antibacterial activity. Levofloxacin diffuses through the bacterial cell wall and acts by inhibiting DNA gyrase (bacterial topoisomerase II), an enzyme required for DNA replication, RNA transcription, and repair of bacterial DNA. Inhibition of DNA gyrase activity leads to blockage of bacterial cell growth. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=37941&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=37941&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C1586" NCI Thesaurus)
Concepts Organic Chemical (T109) , Antibiotic (T195)
MSH D064704
SnomedCT 387552007, 96087006
LNC LP17276-4, MTHU009097
English levofloxacin, levofloxacin (medication), LEVOFLOXACIN, Levofloxacin [Chemical/Ingredient], Levofloxacin, Ofloxacin, (S)-Isomer, Levofloxacin (product), Levofloxacin (substance)
Spanish levofloxacino (producto), levofloxacina, levofloxacino, levofloxacino (sustancia), levofloxacina (producto), levofloxacina (sustancia)
Czech levofloxacin
French Lévofloxacine
German Levofloxacin
Italian Levofloxacina
Russian ЛЕВОФЛОКСАЦИН, ОФЛОКСАЦИН, (S)-ИЗОМЕР, OFLOKSATSIN, (S)-IZOMER, QUIXIN, LEVOFLOKSATSIN

Ontology: moxifloxacin (C0536495)

Definition (NCI) A fluoroquinolone antibiotic with antibacterial activity. Moxifloxacin binds to and inhibits the bacterial enzymes DNA gyrase (topoisomerase II) and topoisomerase IV, resulting in inhibition of DNA replication and repair and cell death in sensitive bacterial species.
Definition (NCI_NCI-GLOSS) A drug used to treat bacterial infections. It is a type of fluoroquinolone.
Concepts Organic Chemical (T109) , Antibiotic (T195)
MSH C104727
SnomedCT 371296007, 408008008, 412439003
LNC LP28720-8, MTHU014635
English 1-cyclopropyl--7-(2,8-diazabicyclo(4.3.0)non-8-yl)-6-fluoro-8-methoxy-1,4-dihydro-4-oxo-3-quinolinecarboxylic acid, moxifloxacin, moxifloxacin [Chemical/Ingredient], Moxifloxacin (product), MOXIFLOXACIN, Moxifloxacin product (product), Moxifloxacin product, MOXI, Moxifloxacin, Moxifloxacin (substance)
Spanish moxifloxacina, producto (producto), moxifloxacina, producto, moxifloxacina (producto), moxifloxacino (sustancia), moxifloxacino, moxifloxacina, moxifloxacina (sustancia), moxifloxacino (producto)

Ontology: Levaquin (C0721336)

Definition (CHV) brand name levofloxacin
Definition (CHV) brand name levofloxacin
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D064704
English levaquin, levaquin [brand name], Levaquin
Czech Levaquin
Italian Levaquin

Ontology: Zagam (C0724448)

Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH C061363
English Zagam, sparfloxacin (Zagam), Aventis Behring brand of sparfloxacin, Bertek brand of sparfloxacin

Ontology: gatifloxacin (C0753645)

Definition (NCI) A synthetic 8-methoxyfluoroquinolone with antibacterial activity against a wide range of gram-negative and gram-positive microorganisms. Gatifloxacin exerts its effect through inhibition of DNA gyrase, an enzyme involved in DNA replication, transcription and repair, and inhibition of topoisomerase IV, an enzyme involved in partitioning of chromosomal DNA during bacterial cell division.
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH C078049
SnomedCT 371238005, 116349004
LNC LP28719-0, MTHU014634
English 1-cyclopropyl-1,4-dihydro-6-fluoro-8-methoxy-7-(3-methyl-1-piperazinyl)-4-oxo-3-quinolinecarboxylic acid, 3-Quinolinecarboxylic acid, 1-cyclopropyl-6-fluoro-1,4-dihydro-8-methoxy-7-(3-methyl-1-piperazinyl)-4-oxo-, 1-cyclopropyl-6-fluoro-8-methoxy-7-(3-methylpiperazin-1-yl)-4-oxo-quinoline-3-carboxylic acid, Gatifloxacin product, gatifloxacin (medication), gatifloxacin, gatifloxacin [Chemical/Ingredient], GATIFLOXACIN, Gatifloxacin (product), Gatifloxacin (substance), Gatifloxacin, Gatifloxacin product (product)
Spanish gatifloxacina (producto), gatifloxacina (sustancia), gatifloxacino (sustancia), gatifloxacina, gatifloxacino, gatifloxacino (producto)

Ontology: Avelox (C0875968)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C104727
English Avelox, avelox, Avalox, Bayer brand of moxifloxacin hydrochloride, Izilox, Actira

Ontology: Tequin (C0876180)

Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH C078049
English Tequin, tequin