Third-generation fluoroquinolone
ATC code: J01MA12 (Levofloxacin)
Brand names
Tavanic, Levaquin, Levofloxacino Cinfa, Levofloxacino Normon
An L-isomer of ofloxacin with 2× higher activity. Inhibits bacterial topoisomerase II (DNA gyrase) and topoisomerase IV. Spectrum covers gram-negatives (E. coli, Klebsiella, Pseudomonas aeruginosa, Haemophilus influenzae), gram-positives (Streptococcus pneumoniae including penicillin-resistant, methicillin-susceptible Staphylococcus aureus), and atypical pathogens (Mycoplasma, Chlamydia, Legionella). in 2019 substantially restricted fluoroquinolone indications due to severe adverse effects.
Second line
Second-line for community-acquired pneumonia. Dose 500–750 mg once daily for 5–7 days. /ATS 2019 and SEPAR 2024 set high-dose or amoxicillin + macrolide as first-line outpatient CAP. Levofloxacin is used in penicillin allergy, severe disease with resistant pneumococcus risk, or comorbidities (COPD, diabetes).
Second line
Second-line for acute pyelonephritis per EAU 2024 and 2010. Dose 500–750 mg once daily for 5–7 days. Not used in uncomplicated cystitis in non-pregnant women – first-line is fosfomycin or nitrofurantoin ( 2019 restriction).
Second line
Used in severe COPD exacerbation with Pseudomonas aeruginosa risk (severe COPD with bronchiectasis, frequent antibiotic courses) per 2024 and GesEPOC 2021. Dose 500 mg once daily for 5–7 days.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Levofloxacin is prescribed for bronchitis, upper respiratory infections and presumed pneumonia without radiographic confirmation. 2024 AWaRe and 2019 confine fluoroquinolones to serious infections. The 2018 PRAC and boxed warning curtailed routine use due to tendinopathy, peripheral neuropathy and aortic aneurysm risk. Use in viral infections is not indicated.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Direct links to regulator labels. Open in a new tab.
Boxed warning
FDA boxed warning: tendinitis, tendon rupture, peripheral neuropathy, psychiatric disorders; myasthenia gravis exacerbation; raised aortic aneurysm and dissection risk. Use only when alternatives are unavailable.
Contraindicated. β-lactams, macrolides, or cephalosporins are preferred in pregnant patients with severe infection.
Contraindicated during lactation.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Levofloxacin is evaluated for the following indications with varying evidence strength: Community-acquired pneumonia (evidence tier A), Community-acquired urinary tract infection (evidence tier A), COPD exacerbation (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of Levofloxacin (≥ 1 in 100): Nausea and diarrhea, Headache, Dizziness, Insomnia, Candidiasis, QT prolongation. See the Safety section for uncommon and serious reactions.
FDA category C. Contraindicated. β-lactams, macrolides, or cephalosporins are preferred in pregnant patients with severe infection.
Contraindicated during lactation.
Levofloxacin is contraindicated in: Hypersensitivity to levofloxacin or fluoroquinolones; Age under 18 (rare exceptions – inhalation anthrax); Pregnancy and lactation; Epilepsy; Prior tendinitis or tendon rupture with fluoroquinolones. Full list in the Safety section.
FDA boxed warning: tendinitis, tendon rupture, peripheral neuropathy, psychiatric disorders; myasthenia gravis exacerbation; raised aortic aneurysm and dissection risk. Use only when alternatives are unavailable.