Levofloxacin, fluoroquinolone type antibiotic

Levofloxacin 258 is a third generation of fluoroquinolone type antibiotic. This medicine is effective against a number of Gram-positive and Gram-negative bacteria. Because of its broad spectrum of action, 258 is frequently used for symptomatic treatment of infections of unknown etiology. 

The fluoroquinolone subclass of antibiotics is inspired by nalidixic acid (A.35), an older antibiotic commonly used for urinary tract infections (Figure A.10). Depending on the type of infection, fluoroquinolones inhibit DNA gyrase and/or topoisomerase IV. Both enzymes are vital for DNA replication and bacterial reproduction. Both ciprofloxacin (Cipro, A.36) and levofloxacin (Levaquin, A.37) are examples of fluoroquinolone antibiotics. Ciprofloxacin received national attention in the United States in 2001. Ciprofloxacin was used to treat many anthrax-infected patients after letters containing anthrax spores were sent through the U.S. postal service. 

Many other commonly used antibiotics can cause psychiatric symptoms, for example, clarithromycin (trade name, Biaxin)—which is frequently used to treat respiratory illness, ear infections, and skin infections—has been reported to cause mania in some patients. Metronidazole (trade name Flagyl), which is used to treat many types of infections—from parasites to vaginal infections and abscesses—has been reported to cause depression, agitation, confusion, hallucinations, and mania. Trimethoprim-sulfamethoxazole (trade names Bactrim and Septra)—which is used, for example, for bladder infections and sinus and ear infections—has been reported to cause delirium, psychosis, depression, and hallucinations in rare cases. The fluoroquinolone antibiotics—such as ciprofloxacin (trade name Cipro), levofloxacin (trade name Levaquin), ofloxacin (trade name Floxin), trovafloxacin (trade name Trovan), and others of this class—can cause psychiatric symptoms fairly often, including confusion, agitation, depression, insomnia, mania, paranoia, and psychosis. 

At least four different types of empirical parenteral antibiotic regimens are in use (1) monotherapy with an antipseudomonal cephalosporin (cefepime or ceftazidime) or antipseudomonal car-bapenem (imipenem-cilastatin or meropenem), (2) combination therapy with an aminoglycoside plus an antipseudomonal penicillin (piperacillin-tazobactam or ticarciUin-clavulate), an antipseudomonal cephalosporin, or an antipseudomonal carbapenem, (3) vancomycin plus an antipseudomonal cephalosporin or antipseudomonal carbapenem, with or without an aminoglycoside, and (4) a fluoroquinolone (ciprofloxacin or levofloxacin) in combination with an... 

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