Dosing & Uses

Levofloxacin mechanism of action

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Fluoroquinolones, including Levofloxacin, are associated with an increased risk of tendinitis and tendon rupture in all ages. Fluoroquinolones, including Levofloxacin, may exacerbate muscle weakness in persons with myasthenia gravis. Levofloxacin is a synthetic broad-spectrum antibacterial agent for oral administration. Chemically, levofloxacin, a chiral fluorinated carboxyquinolone, is the pure - - S -enantiomer of the racemic drug substance ofloxacin.

The chemical name is - - S fluoro-2,3-dihydromethyl 4-methyl piperazinyl oxo-7H-pyrido[1,2,3-de]-1,4-benzoxazinecarboxylic acid hemihydrate.

The Chemical Structure of Levofloxacin. Levofloxacin is levofloxacin mechanism of action light yellowish-white to yellow-white crystal or crystalline powder. The molecule exists as a levofloxacin mechanism of action at the pH conditions in the small intestine. The data demonstrate that from pH 0. Levofloxacin is considered soluble to freely soluble in this pH range, as defined by USP nomenclature.

Levofloxacin has the potential to form stable coordination compounds with many metal ions. This in vitro chelation potential has the following formation order: The appearance of Levofloxacin Oral Solution may range from clear yellow to clear greenish-yellow. This does not adversely affect product potency.

Levofloxacin Oral Solution contains the following inactive ingredients: It may also contain a solution of sodium hydroxide for pH adjustment. To reduce the development of drug-resistant bacteria lesson plans about multiple intelligences maintain the effectiveness of Levofloxacin and other antibacterial drugs, Levofloxacin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.

When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy. Appropriate culture and susceptibility tests should be performed before treatment in levofloxacin mechanism of action to isolate and identify organisms causing the infection and to determine their susceptibility to levofloxacin [see Microbiology ].

Therapy with Levofloxacin may be initiated before results of these tests are known; once results become available, appropriate therapy should be selected. As with other drugs in this class, some isolates of Pseudomonas aeruginosa may develop resistance fairly rapidly during treatment with Levofloxacin. Culture and susceptibility testing performed periodically during therapy will provide information about the continued susceptibility of the pathogens to the antimicrobial agent and also the possible emergence of bacterial resistance.

Levofloxacin is indicated for the treatment of nosocomial pneumonia due to methicillin -susceptible Staphylococcus aureus, levofloxacin mechanism of action, Pseudomonas aeruginosa, Serratia marcescens, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, or Streptococcus pneumoniae. Adjunctive therapy should be used as clinically indicated. MDRSP isolates are isolates resistant to two levofloxacin mechanism of action more of the following antibacterials: Levofloxacin is indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis [see Clinical Studies ].

Levofloxacin is indicated for the treatment of acute bacterial exacerbation of chronic bronchitis due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniaeHaemophilus influenzae, Haemophilus parainfluenzae, or Moraxella catarrhalis.

Levofloxacin is indicated for the treatment of complicated skin and skin structure infections due to methicillin-susceptible Staphylococcus aureus, Enterococcus faecalis, Streptococcus pyogenes, or Proteus mirabilis [see Clinical Studies ]. Levofloxacin is indicated for the treatment of uncomplicated skin and skin structure infections mild to moderate including abscesses, cellulitisfuruncles, impetigopyoderma, wound infections, due to methicillin-susceptible Staphylococcus aureus, or Streptococcus pyogenes.

Levofloxacin is indicated for the treatment of chronic bacterial prostatitis due to Escherichia coli, Enterococcus faecalis, or methicillin-susceptible Staphylococcus epidermidis [see Clinical Studies ]. Levofloxacin is indicated for the treatment of complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis [see Clinical Studies ].

Levofloxacin is indicated for the treatment of complicated urinary tract infections mild to moderate due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa [see Clinical Studies ], levofloxacin mechanism of action. Levofloxacin is indicated for the treatment of acute pyelonephritis caused by Escherichia coliincluding cases with concurrent bacteremia [see Clinical Studies ]. Levofloxacin is indicated levofloxacin mechanism of action the treatment of uncomplicated urinary tract infections mild to moderate due to Escherichia coli, Klebsiella pneumoniae, levofloxacin mechanism of action, or Staphylococcus saprophyticus.

Levofloxacin is indicated for inhalational anthrax post-exposure levofloxacin mechanism of action reduce the incidence or progression of disease following exposure to aerosolized Bacillus anthracis. The effectiveness of Levofloxacin is based on plasma concentrations achieved in humans, a surrogate endpoint reasonably likely to predict clinical benefit.

Levofloxacin has not been tested in humans for the post-exposure prevention of inhalation anthrax. The safety of Levofloxacin in adults for durations of therapy beyond 28 days or in pediatric patients for durations of therapy beyond 14 days has not been studied. Levofloxacin is indicated for levofloxacin mechanism of action of plagueincluding pneumonic and septicemic plague, due to Yersinia pestis Y.

Efficacy studies of Levofloxacin could not be conducted in humans with plague for ethical and feasibility reasons. The usual dose of Levofloxacin Oral Solution is barbados plan of action, mg, or mg administered orally every 24 hours, levofloxacin mechanism of action, as indicated by infection and described in Table 1.

This indication is based on a surrogate endpoint. Levofloxacin plasma concentrations achieved in humans are reasonably likely to predict clinical benefit [see Clinical Studies ]. Prolonged Levofloxacin therapy should only be used when the benefit outweighs the risk.

Higher doses of Levofloxacin typically used for treatment of pneumonia can be used for treatment of plague, if clinically indicated. Administer Levofloxacin mechanism of action with caution in the presence of renal insufficiency, levofloxacin mechanism of action. Careful clinical observation and appropriate laboratory studies should be performed prior to and during therapy since elimination of levofloxacin may be reduced.

If treating uncomplicated UTI, then no dosage adjustment is required No information on dosing adjustment is available. It is recommended that Levofloxacin Oral Solution be taken 1 hour before or 2 hours after eating. Adequate hydration of patients receiving oral Levofloxacin should be maintained to prevent the formation of highly concentrated urine. Levofloxacin Oral Solution is supplied in a 16 oz.

The following serious and otherwise important adverse drug reactions are discussed in greater detail in other sections of labeling:.

Crystalluria and cylindruria have been reported with quinolones, including Levofloxacin. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates levofloxacin mechanism of action in practice.

The data described below reflect exposure to Levofloxacin in patients in 29 pooled Phase 3 clinical trials.

Patients received Levofloxacin doses of mg once daily, mg once daily, or mg once or twice daily. Treatment duration was usually 314 days, and the mean number of days on therapy was 10 days. The overall incidence, type and levofloxacin mechanism of action of adverse reactions was similar in patients receiving Levofloxacin doses of mg once daily, levofloxacin mechanism of action, mg once daily, and mg once or twice daily.

Discontinuation of Levofloxacin due to adverse drug reactions occurred in 4. The most common adverse drug reactions leading to discontinuation with the and mg doses were gastrointestinal 1, levofloxacin mechanism of action. The most common adverse drug reactions leading to discontinuation with the mg dose were gastrointestinal 1. In clinical trials using multiple-dose therapy, ophthalmologic abnormalities, including cataracts and multiple punctate lenticular opacities, have been noted in patients undergoing treatment with quinolones, including Levofloxacin.

The relationship of the drugs to these events is not presently established, levofloxacin mechanism of action. Table 6 lists adverse reactions that have been identified during post-approval use of Levofloxacin. While the chelation by divalent cations is less marked than with other fluoroquinolones, concurrent administration of Levofloxacin Oral Solution with antacids containing magnesium, or aluminum, as well as sucralfatemetal cations such as iron, and multivitamin preparations with zinc may interfere with the gastrointestinal absorption of levofloxacin, resulting in systemic levels considerably lower than desired.

Tablets with antacids containing magnesium, aluminum, as well as sucralfate, metal cations such as iron, and multivitamin preparations with zinc or didanosine may substantially interfere with the gastrointestinal absorption of levofloxacin, resulting in systemic levels considerably lower than desired. These agents should be taken at least two hours before or two hours after oral Levofloxacin administration. No significant effect of Levofloxacin on the peak plasma concentrations, AUC, and other disposition parameters for R- and S- warfarin was detected in a clinical study involving healthy volunteers.

Similarly, no apparent effect of warfarin on levofloxacin absorption and disposition was observed. However, there have been reports during the postmarketing experience in patients that Levofloxacin enhances the effects of warfarin, levofloxacin mechanism of action. Elevations of the prothrombin time in the setting of concurrent warfarin and Levofloxacin use have been associated with episodes of bleeding. Prothrombin time, International Normalized Ratio INRor other suitable anticoagulation tests should be closely monitored if Levofloxacin is administered concomitantly with warfarin.

Disturbances of blood glucose, including hyperglycemia and hypoglycemiahave been reported in patients treated concomitantly with fluoroquinolones and an antidiabetic agent. No significant effect of Levofloxacin on the plasma concentrations, AUC, and other disposition parameters for theophylline was detected in a clinical study involving levofloxacin mechanism of action volunteers.

Similarly, no apparent effect of theophylline on levofloxacin absorption and disposition was observed. However, concomitant administration of other fluoroquinolones with theophylline has resulted in prolonged elimination half-life, elevated serum theophylline levels, and a subsequent increase in the risk of theophylline-related adverse reactions in the patient population. Therefore, theophylline levels should be closely monitored and appropriate dosage adjustments made when Levofloxacin is levofloxacin mechanism of action. No significant effect of Levofloxacin on the peak plasma concentrations, AUC, and other disposition parameters for cyclosporine was detected in a clinical study involving healthy volunteers.

However, elevated serum levels of cyclosporine have been reported in the patient population when coadministered with some levofloxacin mechanism of action fluoroquinolones. The differences, however, are not considered to be clinically significant. Therefore, levofloxacin mechanism of action, no dosage adjustment is required for Levofloxacin or cyclosporine when administered concomitantly. No significant effect of Levofloxacin on the peak plasma concentrations, AUC, and other disposition parameters for digoxin was detected levofloxacin mechanism of action a clinical study involving healthy volunteers.

Levofloxacin absorption and disposition kinetics were similar in the presence or absence of digoxin. Therefore, no dosage adjustment for Levofloxacin or digoxin is required when administered concomitantly.

No significant effect of probenecid or cimetidine on the C of levofloxacin was observed in a clinical study involving healthy volunteers. However, levofloxacin mechanism of action changes do not warrant dosage adjustment for Levofloxacin when probenecid or cimetidine is co-administered. Some fluoroquinolones, including Levofloxacin, may produce false-positive urine screening results for opiates using commercially available immunoassay kits. Confirmation of positive opiate screens by more specific methods may be necessary.

This adverse reaction most frequently involves the Achilles tendonlevofloxacin mechanism of action, and rupture of the Achilles tendon may require surgical repair.

Tendinitis and tendon rupture in the rotator cuff the shoulderthe hand, the bicepsthe thumb, and other tendon sites have also been reported. The risk of developing fluoroquinolone-associated tendinitis and tendon rupture is further increased in complaints about medicare advanatage plans patients usually over 60 years of age, in those taking corticosteroid drugs, and in patients with kidney, heart or lung transplants.

Factors, in addition to age and corticosteroid use, that may independently increase the risk of tendon rupture include strenuous physical activity, levofloxacin mechanism of action, renal failure, and previous tendon disorders such as rheumatoid arthritis.

Tendinitis and tendon rupture have been reported in patients taking fluoroquinolones who do not have the above risk factors, levofloxacin mechanism of action. Tendon rupture can occur during or after completion of therapy; cases occurring up to several months after completion of therapy have been reported.

Levofloxacin should be discontinued if the patient experiences pain, swelling, inflammation or rupture of a tendon. Patients should be advised to rest at the first sign of tendinitis or tendon rupture, and to contact their healthcare provider regarding changing to a non-quinolone antimicrobial drug.

Fluoroquinolones, including Levofloxacin, levofloxacin mechanism of action, have neuromuscular blocking activity and may exacerbate muscle weakness in persons with myasthenia gravis. Postmarketing serious adverse events, including deaths and requirement for ventilatory support, have been associated with fluoroquinolone use in persons with myasthenia gravis.

 

Levofloxacin mechanism of action

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