Levofloxacin

INTRODUCTION

Indications

PO, IV: Treatment of the following bacterial infections: Urinary tract infections, including cystitis, pyelonephritis, and prostatitis; Respiratory tract infections, including acute sinusitis, acute exacerbations of chronic bronchitis, community-acquired pneumonia, and nosocomial pneumonia; Uncomplicated and complicated skin and skin structure infections. Postexposure treatment of inhalational anthrax.

Action

Inhibits bacterial DNA synthesis by inhibiting DNA gyrase enzyme. Therapeutic Effects: Death of susceptible bacteria. Spectrum: Active against gram-positive pathogens, including Staphylococcus aureus, S. epidermidis, S. saprophyticus, Streptococcus pyogenes, S. pneumoniae, Enterococcus faecalis, Bacillus anthracis. Gram-negative spectrum notable for activity against: Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Proteus mirabilis, Pseudomonas aeruginosa, Serratia marcescens, Haemophilus influenzae, Moraxella catarrhalis. Additional spectrum includes Chlamydophylia pneumoniae, Legionella pneumoniae, Mycoplasma pneumoniae.

Adverse Reactions/Side Effects

CNS: SEIZURES, dizziness, drowsiness, headache, insomnia, agitation, confusion. CV: QTc prolongation, ARRHYTHMIAS. GI: HEPATOTOXICITY, PSEUDOMEMBRANOUS COLITIS, abdominal pain, diarrhea, nausea, vomiting. GU: vaginitis. Derm: photosensitivity, rash. Endo: hyperglycemia, hypoglycemia. Local: phlebitis at IV site. Neuro: peripheral neuropathy. MS: arthralgia, tendinitis, tendon rupture. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for seizures; notify physician immediately if patient develops or increases seizure activity.

• Monitor signs of hypersensitivity reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, angioedema, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucus in stools, and other severe or prolonged GI problems (nausea, vomiting, heartburn). Notify physician or nursing staff immediately of these signs.

• Be alert for signs of hepatotoxicity, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Report these signs to the physician.

• Assess any tendon pain or joint pain. Tendinopathy and rupture can occur, especially in large, weight-bearing tendons (Achilles, patellar tendons). Risk of tendon damage is greater in patients >65 yr old, transplant recipients (i.e., kidney, heart, lung), patients with preexisting tendon damage, and patients taking corticosteroids concurrently.

• Monitor signs of peripheral neuropathy (numbness, tingling). Perform objective tests (nerve conduction, monofilaments) to document any neuropathic changes.

• Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Be alert for confusion, agitation, or other alterations ...