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Methicillin Resistant Staphylococcus Aureus (MRSA): Levofloxacin is not effective against infection that caused by MRSA. In infections suspected of being caused by MRSA, levofloxacin should be combined with other drugs to treat the infection.
Tendinitis and tendon crack: Tendinitis may be rare. This most often involves Achilles tendon and may cause tendon cracking. The risk of tendinitis and tendon cracking is elevated in elderly patients and patients taking corticosteroids. Close monitoring for patients who are receiving levofloxacin should be performed. Patients should consult a physician if they have symptoms of tendinitis.
If tendinitis is suspected, discontinue levofloxacin therapy immediately, and do appropriate treatment (such as immobilization) especially in the affected tendon.
Clostridium difficile-related disease: Diarrhea, especially in severe, persistent and/or bleeding diarrhea, during or after treatment with levofloxacin, it may be the symptoms of Clostridium difficile-related disease, the most severe form of the disease is enterocolitis pseudomembrane. If enterocolitis pseudomembrane is suspected, discontinue levofloxacin therapy immediately, and patients should be treated with supportive measures and specific therapy immediately (eg. oral metronidazole or vancomycin). All products those are known as peristaltic inhibitor are contraindicated in clinical situations.
Pseudomembrane colitis has been reported in almost all antibacteries including levofloxacin with mild to life-threatening severity. Therefore, it is important to consider the diagnosis to provide other antibacterial in patients with diarrhea.
Treatment with antibacterial may alters the normal flora of the colon and causes excess growth of Clostridia. Studies show that toxins produced by Clostridium difficile are the main causes of antibiotics associated with colitis.
After diagnosis of pseudomembranous colitis, treatment steps should be initiated. Mild cases of colic pseudomembranes usually can be stopped by discontinuation of the drug alone. In moderate to severe cases, other considerations should be made to overcome it with the administration of electrolyte fluids, protein supplements and effective antibacterial treatment against colitis that caused by Clostridium difficile.
Patients who are prone to seizures/convulsion: Tablets of levofloxacin contraindicated in patients with a history of epilepsy such as other quinolones, should be used with extreme caution in patients with impaired central nervous system, treatment is administered in conjunction with the same non-steroidal fenbufen and anti-inflammatory drugs or medications that lower the brain seizure threshold, such as theophylline.
Patients with dehydrogenase G-6-phosphate deficiency: Patients with latent or actual defects in glucose-6-phosphate dehydrogenase may be susceptible to hemolytic reactions when receiving treatment with quinolone antibacterials, and levofloxacin should be used with full caution.
Patients with renal impairment: Levofloxacin administration in patients with renal impairment should be very careful. Clinical observations and appropriate laboratory studies should be performed before and during therapy since levofloxacin elimination can be reduced. In patients with renal impairment (CrCl <80 mL/min), dose adjustment should be done to avoid levofloxacin accumulation due to clearance reduction.
Hypersensitivity reaction: Levofloxacin may cause fatal hypersensitivity reactions (such as angioedema to anaphylactic shock), sometimes after an initial dose administration. The therapy should be discontinued and contact the doctor to provide medical treatment immediately.
Serious acute hypersensitivity reactions may require treatment with epinephrine and other resuscitation measures, including oxygen, intravenous fluids, antihistamines, corticosteroids, amines, and airways management if it is clinically indicated.
Hypoglycemia: Like the other quinolones, blood glucose disorders, including symptomatic hyper and hypoglycemia, have been reported after diabetic patients receive drug therapy in conjunction with oral anti-hypoglycemic drugs (such as gliburide/glibenclamide) or with insulin.
Prevention of photosensitization: The therapy should be discontinued in case of phototoxicity happen (such as skin eruption).
Patients treated with vitamin K antagonists: Monitor coagulation test for co-administration levofloxacin and vitamin K antagonists (such as warfarin).
Psychotic reaction: Psychotic reaction has been reported in patients who received quinolones, including levofloxacin. In a very rare case, self-harmed psychotic reaction including suicidal thoughts and action could be happened after single dose administration. Administration of levofloxacin in patients with a history of psychiatric illness should be highly regarded.
Cardiac disorder: Caution should be seriously taken when using fluoroquinolone, including levofloxacin, in patients with known risk factors for prolonged QT interval for example: Built-in prolonged QT syndrome; Concomitant use with drugs known to prolong QT interval (such as class IA and III of anti-arrhythmia drugs, tricyclic antidepressants, macrolides); Undetectable electrolytes imbalance (such as hypokalemia, hypomagnesemia); Elderly; Cardiac disease; Peripheral neuropathy; Opiates; Liver function failure: Cases of liver necrosis to life-threatening liver failure have been reported in the use of levofloxacin, especially in patients with severe disease, such as sepsis.
The side effects may impair the ability to drive or operate machine.
