Levofloxacin
In brief
- Levofloxacin is a prescriptionâonly medicine (POM) in the UK.
- Levofloxacin is an antibacterial (a fluoroquinolone) used to treat respiratory tract infections (including communityâacquired pneumonia, acute sinusitis, chronic bronchitis), urinary tract infections and pyelonephritis, skin and softâtissue infections, prostatitis and complicated intraâabdominal infections; it works by inhibiting bacterial DNA gyrase and topoisomerase IV, enzymes essential for bacterial DNA replication and cell division.
- Usual adult doses vary by indication: commonly 500 mg once daily for many infections (7â14 days), 500 mg twice daily for severe pneumonia, and prostatitis courses up to 28 days; dosing must be adjusted for renal impairment.
- Available forms include oral tablets (250 mg, 500 mg), intravenous infusion (500 mg/100 mL) and 0.5% eye drops.
- Antibacterial activity begins shortly after absorption; plasma concentrations rise within 1â2 hours after an oral dose and clinical improvement is often seen within 24â72 hours, depending on the infection.
- Levofloxacin has a plasma halfâlife of roughly 6â8 hours allowing onceâdaily dosing; the total course duration depends on the type and severity of infection (typically 5â28 days as advised by a clinician).
- Avoid excessive alcohol while taking levofloxacin â alcohol can worsen side effects such as dizziness and may impair recovery; there is no specific interaction requiring complete abstinence, but caution is advised.
- The most common side effect is nausea; other frequent adverse effects include headache, diarrhoea, insomnia and dizziness â serious risks include tendonitis/tendon rupture, CNS effects (confusion, seizures) and QT prolongation.
- Would you like to try levofloxacin without a prescription?
Basic levofloxacin information
- INN (international nonproprietary name): Levofloxacin.
- Brand names available in the United Kingdom: Tavanic; generic levofloxacin tablets and infusions.
- ATC code: J01MA12.
- Forms and strengths: tablets 250 mg, 500 mg; IV infusion 500 mg/100 mL; 0.5% eye drops.
- OTC / Rx classification: Prescription-only medicine (POM) in the UK; no authorised OTC versions.
Clinical effectiveness in the United Kingdom
Do patients get better quickly on levofloxacin?
In UK clinical practice levofloxacin is recognised for reliable oral bioavailability and broad Gramânegative coverage.
It is used selectively in NHS secondary care and some primaryâcare settings for documented or highârisk infections where alternatives are unsuitable.
UK practice emphasises guided use: microbiology susceptibility results, local formulary approval and documented indications to avoid overuse.
In hospitals IV levofloxacin (500 mg/100 mL) is reserved for severe infections or when oral intake is compromised.
Stepâdown to oral 500 mg tablets is common once the patient is clinically stable.
| Route | When used | Effectiveness notes |
|---|---|---|
| Oral | Documented susceptible infection, stepâdown from IV | High bioavailability; effective for many systemic infections |
| IV | Severe infection, poor oral intake | Used in hospital; allows rapid therapeutic levels |
Indications and expanded uses
What is levofloxacin usually prescribed for in the NHS?
- Communityâacquired pneumonia
- Included among MHRA/NICEâaligned indications when appropriate.
- Complicated urinary tract infections including pyelonephritis
- The standard regimen is 500 mg once daily.
- Complicated intraâabdominal infections
- Used alongside metronidazole where indicated.
- Exacerbations of chronic bronchitis
- Limited, guidelineâdirected use.
- Prostatitis
- Extended courses (eg 28 days) may be used where indicated.
- Ophthalmic use
- 0.5% eye drops for ocular surface infections where topical fluoroquinolones are appropriate.
Offâlabel uses occur in specialist settings for resistant infections and require infectiousâdisease approval and stewardship signâoff in NHS hospitals.
| Licensed use | Common offâlabel use |
|---|---|
| Complicated UTI, pneumonia, prostatitis | Part of multiâdrug regimens for resistant organisms (specialist only) |
| Complicated intraâabdominal infection (with metronidazole) | Postâexposure prophylaxis in defined scenarios (specialist decision) |
Paediatric and pregnancy use is generally avoided unless benefits outweigh risks and specialist approval is obtained.
Composition and brand landscape
Who makes levofloxacin and what formats are common?
Levofloxacin is the International Nonproprietary Name (INN) for the active substance.
In the UK it is available as Tavanic and as generic levofloxacin tablets and infusions.
Common packaging formats are blister packs for tablets and readyâtoâuse 500 mg/100 mL infusions.
Manufacturers include Sanofi (Tavanic), Daiichi Sankyo and several generic suppliers.
| Formulation | Typical pack size/note |
|---|---|
| Tablets 250 mg, 500 mg | Blister packs commonly used |
| IV infusion 500 mg/100 mL | Readyâtoâuse infusions for inpatient use |
| Ophthalmic 0.5% drops | Topical packs for ocular infections |
In UK pharmacies levofloxacin is a prescriptionâonly medicine (POM) and is dispensed against NHS or private prescriptions, with pharmacist counselling.
Our online pharmacy offers discreet delivery to the United Kingdom in 9â21 days.
Contraindications and special precautions
Who should not take levofloxacin?
Absolute contraindications include allergy to levofloxacin or other quinolones and a history of quinoloneârelated tendon disorders.
Special precautions include avoiding routine use in children and adolescents unless essential, and careful consideration in pregnancy and breastfeeding.
Assess seizure history and QTâinterval risk before prescribing or dispensing.
Elderly patients need dose assessment according to renal function rather than age alone because renal impairment is common.
Advise patients not to drive or operate machinery if they experience dizziness or visual disturbances.
Warn about photosensitivity and recommend sun protection while taking the medicine.
Alcohol is not strictly contraindicated but may worsen central nervous system side effects; counsel moderation.
- Pharmacy counselling checklist: allergies, prior tendon problems, current QTâprolonging drugs, pregnancy/breastfeeding status, renal function.
- Absolute contraindications
- Allergy to levofloxacin or other quinolones; prior quinoloneârelated tendon disorders; children/adolescents unless essential.
- Relative contraindications
- QT prolongation, seizure disorders, significant renal impairment, pregnancy and breastfeeding (generally avoided).
Dosage guidelines
What dose should a typical adult take?
Standard adult dosing used in UK practice mirrors licensed regimens: 500 mg once daily for many infections, and 500 mg twice daily for some severe infections such as communityâacquired pneumonia.
In hospital, 500 mg/100 mL infusions are used with oral stepâdown to tablets (250/500 mg) once stable.
Renal impairment dosing adjustments are important and guided by creatinine clearance.
For CrCl 20â49 mL/min: give 500 mg once, then 250 mg once daily.
For CrCl below 20 mL/min: give 500 mg once, then 250 mg every 48 hours (local formularies may vary).
No routine hepatic dose adjustment is required because renal clearance predominates.
Missed doses should be taken as soon as remembered unless close to the next dose, and double dosing must be avoided.
Overdose is a medical emergency; monitor ECG, central nervous system status and renal function and seek urgent care.
| Indication | Usual dose | Typical duration | Renal adjustment |
|---|---|---|---|
| Communityâacquired pneumonia | 500 mg once or twice daily | 7â14 days | Adjust per CrCl (see notes) |
| Complicated UTI | 500 mg once daily | 7â14 days | 500 mg once then 250 mg once daily if CrCl 20â49 mL/min |
| Pyelonephritis | 500 mg once daily | 7â10 days | Adjust per CrCl |
Interactions overview
Will other medicines affect how levofloxacin works?
Antacids, iron, sucralfate and multivalent cations reduce levofloxacin absorption; advise separating doses by at least 2â4 hours.
Coâprescription with QTâprolonging drugs such as macrolides and some antiarrhythmics raises the risk of torsades de pointes; consider ECG and electrolyte checks where appropriate.
Concomitant corticosteroids increase the risk of tendon injury and should be used cautiously together with levofloxacin.
Seizureâthresholdâlowering drugs and nonâsteroidal antiâinflammatories merit caution because of potential additive central nervous system effects.
Food does not strictly restrict dosing, but dairy and calciumâfortified products may reduce absorption if taken at the same time.
- Key interactions by severity: severe â QTâprolonging drugs, systemic corticosteroids; moderate â antacids and multivalent cations; minor â food effects.
| Agent | Advice |
|---|---|
| Antacids / Iron / Calcium | Separate by 2â4 hours to preserve absorption |
| Macrolides / some antiarrhythmics | Check ECG and electrolytes; avoid if possible |
Comparable medicines and preferences
Which antibiotics are considered before levofloxacin?
NHS antimicrobial guidance generally favours narrowerâspectrum agents before fluoroquinolones, when appropriate.
Common comparators include ciprofloxacin, moxifloxacin and betaâlactams or macrolides depending on the indication.
Pros of levofloxacin are its high oral bioavailability, onceâdaily dosing and IV/oral interchangeability.
Cons are the class safety concerns â tendons, neuropathy, QT prolongation and central nervous system effects â plus resistance pressure and stewardship restrictions.
| Agent | Spectrum / notes | Key safety flags |
|---|---|---|
| Levofloxacin | Broad Gramânegative, some atypical coverage; IV/oral switch possible | Tendon injury, neuropathy, QT, CNS effects |
| Ciprofloxacin | Strong Gramânegative activity; common alternative | Similar class risks to levofloxacin |
| Moxifloxacin | Better atypical coverage | Higher QT risk; stewardship concerns |
Local formularies and microbiology teams guide choice based on susceptibility, site of infection and patient comorbidities.
FAQ â common NHS patient questions
Can I get levofloxacin on the NHS for a chest infection?
Yes, but only if firstâline agents are unsuitable or resistance patterns indicate fluoroquinolone use; hospital assessment or microbiology advice is common.
Is it safe in pregnancy or breastfeeding?
Levofloxacin is generally avoided in pregnancy and breastfeeding unless a specialist decides the benefits outweigh the risks.
What if I develop tendon pain?
Stop the medicine immediately, avoid sporting or heavy activity, seek urgent GP or A&E assessment and report the incident via MHRA Yellow Card.
Do I need a prescription for levofloxacin?
Yes â levofloxacin is a prescriptionâonly medicine in the UK and is supplied with a valid prescription and pharmacist consultation.
Guidelines for proper use (pharmacist and NHS counselling)
What should a pharmacist check before dispensing?
Confirm the indication and any allergies or prior quinolone reactions.
Review current medications for QTâprolonging drugs, antacids, steroids and seizureâthresholdâlowering agents.
Check renal function and age considerations and advise dose adjustment where needed.
Explain dosing schedule clearly and recommend taking the dose at the same time each day.
Advise on separating cationic products by 2â4 hours and on common side effects such as nausea, dizziness and tendon pain.
Document counselling in the pharmacy record and provide printed information or an NHS app message.
For hospital transitions, ensure criteria for IVâtoâoral switch and stewardship justification are recorded in the notes.
Encourage MHRA Yellow Card reporting for suspected adverse reactions and signpost NHS 111 or urgent GP review for severe reactions.
- Pharmacist counselling checklist: indication, allergies, interacting drugs, renal function, dosing schedule, when to stop and seek help.
| When to stop and seek help | Action |
|---|---|
| New tendon pain or swelling | Stop drug, avoid exercise, seek urgent medical review |
| Severe dizziness, visual changes or confusion | Seek urgent GP or A&E review |
| Signs of allergy (rash, breathing difficulty) | Stop and seek emergency care |
Delivery across the United Kingdom
| City | Region | Delivery Time |
|---|---|---|
| London | England | 9â21 days |
| Birmingham | England | 9â21 days |
| Manchester | England | 9â21 days |
| Glasgow | Scotland | 9â21 days |
| Leeds | England | 9â21 days |
| Liverpool | England | 9â21 days |
| Bristol | England | 9â21 days |
| Edinburgh | Scotland | 9â21 days |
| Sheffield | England | 9â21 days |
| Newcastle Upon Tyne | England | 9â21 days |
| Belfast | Northern Ireland | 9â21 days |
| Cardiff | Wales | 9â21 days |
| Nottingham | England | 9â21 days |
