Fact Checked

What Is Levofloxacin?

Whether you’re currently fighting off pneumonia, have recently been exposed to inhalational anthrax, or are hoping to prevent infection with the plague (yes, that plague), you might be surprised to find that the same medication would be prescribed in all three of these very different situations. Levofloxacin is a powerful type of antibiotic known as fluoroquinolones that are used to treat and prevent a number of serious infections that cannot be treated with other medications. Levofloxacin was prescribed 3,777,117 times in 2017 in the United States alone. Improper prescription and use of antibiotics over the past several decades has led to a rise in drug-resistant bacteria, many of which do not respond to more broad-spectrum and widely used antibiotics; in these situations, levofloxacin can be a helpful alternative, but what is levofloxacin and what should patients know about it?

What Is Levofloxacin?

Levofloxacin, sold under the brand name Levaquin, is a fluoroquinolone antibiotic used to treat bacterial infections. Levaquin, the brand name medication, was first approved by the U.S. Food and Drug Administration (FDA) in 1996 for the treatment of acute bacterial sinusitis, bacterial bronchitis, pneumonia, skin infections, urinary tract infections, and acute pyelonephritis. Levofloxacin belongs to a class of drugs called quinolone antibiotics, and like other antibiotics, it works by stopping the growth of bacteria in the body. Levofloxacin is not effective when used against viral infections such as the common cold, flu, or coronavirus, although antibiotics like it are often incorrectly prescribed for these illnesses.

What Is Levofloxacin Used to Treat?

Levofloxacin has many different treatment applications and can be used to treat a variety of conditions resulting from bacterial infections. Levofloxacin is used to treat community-acquired pneumonia, sinus infection, exacerbation of chronic bronchitis, skin infections, chronic prostate infections, urinary tract infections, kidney infections, inhalation of anthrax, and plague. Levofloxacin is not used for the treatment of common bacterial infections that can be addressed with lower strength broad-spectrum antibiotics, such as acne, or sexually transmitted diseases, like gonorrhea. The medication is sometimes taken with other medications in a strategy called combination therapy. 

What Causes Bacterial Infections?

There’s only one you, but you contain trillions of other tiny living organisms. That’s right, trillions of bacteria make up our microbiome, and these bacteria can be good, bad, or neutral depending on the size of their population within our bodies and their location. You’ve likely heard of the good bacteria, as they are called probiotics. Probiotics help our bodies fight disease and carry out important functions, like digesting food. Bacteria that cause disease are called pathobiotics, while eubiotics is the term given to species of bacteria that can be harmful or helpful depending on the size of the colony and their location. When an imbalance of probiotic and pathobiotic bacteria occurs in our microbiome, we get a bacterial infection.  Usually, the probiotic bacteria in our bodies are able to fight off the pathobiotic bacteria and prevent infection, but when our microbiome gets out of balance, our immune systems can weaken and infection can occur. Antibiotics are commonly used to treat bacterial infections because they work by killing the pathobiotic bacteria that are causing the infection.

How Much Does Levofloxacin Cost?

Levofloxacin is available in the form of tablets and an ophthalmic solution used for eye infections. The medication can also be found in an injectable form, but it is only administered by healthcare professionals and is not purchased over-the-counter at the pharmacy.  Levofloxacin is an inexpensive medication because it is the generic form of Levaquin; the medication is available in 250 mg, 500 mg, and 750 mg strengths. An average prescription of levofloxacin will cost approximately ten dollars to fill regardless of the strength or even the number of pills prescribed. By contrast, the brand name form of the medication, Levaquin, is available at only the 500 mg and 750 strength and will set you back anywhere from 300 - 600 dollars for ten tablets. The costs of brand name medications are often substantially higher than those of the generic form of the medication, so unless you have a medical issue or health condition that requires you to take the brand name form of a drug, you’ll have the same results at a much lower price with the generic version. Levofloxacin is covered by most insurance plans, including Medicare and Medicaid, as well as most commercial insurance programs. However, insurance may not always offer the best prices on prescription drugs. Pharmacy discount card programs like USA Rx also offer savings on all FDA-approved brand name and generic medications, including omeprazole, and patients can sign up for free. 
<h3>What Are the Benefits of Using Levofloxacin?</h3>
Levofloxacin is a powerful antibiotic that is effectively used to treat a number of bacterial infections when other alternative treatment options have failed or cannot be used. It is capable of treating skin, sinus, kidney, bladder, and prostate infections caused by bacteria, and it is used as a second treatment for urinary tract infections, chronic bronchitis, and sinusitis when other treatments are not effective. The medication can also be used to treat certain kinds of lung infections and can be given as a preventative treatment to people who have been exposed to anthrax through inhalation. One major benefit of levofloxacin is that the medication is effective at treating many different types of bacteria, including some that are resistant to other antibiotics that are more commonly used. Both a generic and brand name form of the drug are available, so you are likely to have one of the forms of the medication covered by your insurance company. If you do not have health insurance, levofloxacin and Levaquin are eligible for discounts under any pharmacy discount card program, including USA Rx. 

How Do I Know What Dose of Levofloxacin to Take?

Levofloxacin can only be taken when prescribed by a doctor, so make sure to get medical advice from your doctor about the dose of your medication and how often it should be taken. Depending on the condition being treated the severity of the infection, levofloxacin will be prescribed at different strengths. Levofloxacin is available in 250 mg, 500 mg, and 750 mg tablets and is also available as an ophthalmic solution and an injection given only by healthcare providers. A typical dose of levofloxacin is 500 mg or 750 mg taken once per day, but some conditions that are normally treated by other antibiotics, such as urinary tract infections that have not responded to a different medication, may be treated by the 250 mg dose. It’s imperative that you follow your doctor’s orders directly and do not take the medication for more or less time than prescribed, even if your symptoms have improved. Skipping doses or extending the length of your prescription can increase your risk of further infection by unnecessarily exposing your body to antibiotics, allowing them to become drug-resistant. Follow your doctor’s orders exactly, read the drug information thoroughly, and store it at room temperature.
A single dose of levofloxacin should be taken with a full glass of water each day. If you experience an upset stomach while taking levofloxacin on your first day, check with your doctor to see if taking it with food can help. Levofloxacin is only prescribed to children for the treatment of plague or inhalation of anthrax and is not prescribed for other conditions due to the risks associated with the medication. Senior citizens and people with kidney damage or disease may need to take a lower dosage of the drug to treat their infection, as these groups often have reduced kidney function that causes the drug to build up in their systems in higher quantities, causing an increased risk of side effects.

Are There Any Side Effects I Should Be Aware of?

Levofloxacin can cause both mild and serious side effects. Common side effects associated with levofloxacin that usually do not require medical attention include:

  • Nausea
  • Diarrhea
  • Constipation
  • Headache
  • Insomnia (trouble sleeping)
  • Dizziness

If these common side effects do not subside within a few days or weeks or become more severe, speak to your doctor. 
Rarely, some people may experience adverse effects from levofloxacin that can affect many different parts of the body. In the event of a serious drug reaction, you should seek treatment from a medical professional. Symptoms of an allergic reaction may include:

  • Hives
  • Swelling of the face, lips, and tongue
  • Fast heart rate
  • Skin rash
  • Trouble breathing or swallowing
  • Throat tightness or hoarseness
  • Fainting

Experiencing any of the following is a sign of a medical emergency and treatment should be sought at once:

  • Central nervous system effects, including:
    • Seizures
    • Restlessness
    • Tremors
    • Confusion
    • Trouble sleeping
    • Lightheadedness
    • Suicidal thoughts or actions
    • Hallucinations
    • Anxiety
    • Depression
    • Nightmares
    • Paranoia
    • A headache that will not go away, with or without blurred vision
  • Tendon damage and inflammation, including pain and reduced ability to move
  • Peripheral neuropathy, including pain, numbness, or weakness in the hands, feet, arms, or legs
  • Joint and muscle pain
  • Liver damage, which can sometimes be fatal. Symptoms include
    • Loss of appetite
    • Vomiting
    • Weakness
    • Itching
    • Light-colored bowel movements
    • Dark-colored urine
    • Nausea
    • Fever
    • Tiredness
    • Yellowing of the skin or whites of the eyes
    • Bruising
    • Pain in the abdomen
  • Severe diarrhea caused by Clostridium difficile
    • Watery and bloody stools
    • Fever
    • Stomach pain
  • Heart rhythm problems, including prolongation of the QT interval
    • Loss of consciousness
    • Irregular heartbeat
  • Increased sensitivity to the sun and severe sunburn
  • Low blood sugar

Are There Any Risks Associated With Levofloxacin?

Although levofloxacin is a very effective antibiotic, its medication guide has numerous black box warnings from the FDA, which are the most serious warnings that the agency offers. It is for this reason that levofloxacin is used only to treat serious infections or infections that have not responded to other types of treatment. Black box warnings associated with possible side effects of levofloxacin tablets include:

  • Tendon rupture and tendonitis: Levofloxacin is associated with an increased risk of tendon problems and inflammation of the tendons, like the Achilles tendon, regardless of the age of the patient. However, risks for tendinitis are higher for patients over the age of 60, those taking corticosteroids or people who have had heart, kidney, or lung transplants.
  • Peripheral neuropathy: Levofloxacin can cause damage to the nerves in your hands, arms, feet, and legs, called peripheral neuropathy, that can be permanent.
  • Central nervous system: Levofloxacin can impact your central nervous system and cause convulsions, increased pressure in the head, nerve damage, psychosis, hallucinations, tremors, agitation, anxiety, confusion, and other mental issues. It can also increase suicidal thoughts or actions. 
  • Myasthenia gravis: Levofloxacin can cause a worsening of muscle weakness in patients with myasthenia gravis. These patients should not take levofloxacin.
  • Restricted use: Due to the potential for serious side effects, some of which may be permanent, levofloxacin should only be taken for certain conditions when no other treatment options exist. 

Who Should Not Take Levofloxacin?

People who are allergic to levofloxacin or other quinolone antibiotics should not take levofloxacin. Be sure to tell your doctor about any medications that you are currently taking before you take levofloxacin in case of possible drug interactions. A complete list would include things such as antacids like Carafate, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, and multivitamins. People who have a history of any of the following medical conditions should make sure to give their doctor a complete medical history and family history:

  • Diabetes
  • Kidney damage
  • Myasthenia gravis
  • History of depression or mental illness
  • Heart problems
  • Liver problems

Is Levofloxacin Safe for Pregnant and Nursing Women?

The FDA categorizes levofloxacin as a Category C drug for pregnant women, which means that not enough studies have been done on humans to know how the drug might impact a developing fetus. Research in animals has shown that the drug may cause adverse effects. However, patients and their doctors should carefully weigh the benefits and risks of using the medication before choosing levofloxacin, as a serious infection could also have detrimental impacts on the developing fetus. Levofloxacin does pass into breast milk and cause harmful side effects to a nursing infant, so nursing mothers should talk to their doctors and decide whether to continue taking the drug or whether to stop breastfeeding. 

How Do I Know If Levofloxacin Is Right for Me?

If you are suffering from a bacterial infection, are eighteen years of age older, and do not fall into any of the categories considered at higher risk of side effects from levofloxacin, the medication may be able to effectively treat your condition. Levofloxacin is affordable and available in a variety of strengths, so it is highly accessible. Because levofloxacin is only effective against bacterial, rather than viral, infections, it is critical that you speak to your doctor to ensure that your condition is bacterial prior to starting the medication. Taking levofloxacin incorrectly by skipping doses or not finishing the prescribed course of treatment can have a lasting effect on your body’s response to antibiotics, so only take levofloxacin if you are confident that you will follow the prescription instructions.

Published July 14th, 2020 by Bridget Reed
Fact Checked by Chris Riley

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