Levofloxacin
Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.
| ID | DRUG-LEVOFLOXACIN |
|---|---|
| Тип | Препарат |
| Синоніми | LevaloxLevaquinTavanicЛевофлоксацин |
| Статус | переглянуто 2026-04-27 | очікує клінічного підпису |
| Хвороби | Не вказано |
| Джерела | SRC-NCCN-BCELL-2025 SRC-NCCN-MM-2025 |
Дані про препарат
| Клас | Third-generation respiratory fluoroquinolone (Gram-negative + Pseudomonas + improved Gram-positive incl. S. pneumoniae) |
|---|---|
| Механізм дії | L-isomer of ofloxacin; synthetic respiratory fluoroquinolone that inhibits bacterial DNA gyrase (topoisomerase II, primary in Gram- negatives) and topoisomerase IV (primary in Gram-positives) with bactericidal effect. Compared to ciprofloxacin, levofloxacin has superior Gram-positive activity — particularly against Streptococcus pneumoniae (including penicillin-resistant), viridans streptococci, and methicillin-susceptible Staphylococcus aureus — while retaining comparable Gram-negative coverage including Pseudomonas at the 750 mg dose. Excellent oral bioavailability (~99%) makes IV and PO doses interchangeable. The Gram-positive enhancement is the basis for its use in febrile neutropenia (FN) PROPHYLAXIS in high-risk patients (anticipated ANC <100/µL ≥7 days), where viridans streptococcal bacteremia from oral mucositis is a major source. FDA-approved 1996. |
| Типове дозування | Febrile neutropenia prophylaxis (high-risk hematologic, adult): 500 mg PO/IV once daily, started day of conditioning / induction through ANC recovery (>500/µL). Severe pneumonia / Pseudomonas coverage: 750 mg IV/PO once daily. Uncomplicated UTI: 250 mg PO daily × 3 days. Complicated UTI / pyelonephritis: 750 mg PO/IV daily × 5 days. Pediatric (limited use, generally avoided due to arthropathy concerns): 8-10 mg/kg IV/PO q12h or q24h depending on age. Renal adjustment: CrCl 20-49 → 750 mg first dose then 750 mg q48h (or 500 mg first then 250 mg q24h); CrCl 10-19 → 750 mg first then 500 mg q48h (or 500 mg first then 250 mg q48h); HD/CRRT → same as CrCl 10-19. Hepatic: no adjustment. CRITICAL:... |
| Зареєстровано в Україні | True |
| Відшкодовується НСЗУ | True |
| Остання перевірка для України | 2026-04-27 |
Застереження
- Tendinitis and tendon rupture (Achilles tendon most common; risk increased by age >60, corticosteroid use, organ transplantation, renal failure)
- Peripheral neuropathy (can be permanent)
- CNS effects (toxic psychosis, seizures, anxiety, depression, suicidal ideation, confusion)
- Exacerbation of myasthenia gravis (life-threatening respiratory weakness)
- Aortic aneurysm and dissection (especially in elderly)
- Class warning: avoid in uncomplicated infections (sinusitis, bronchitis, uncomplicated UTI) where alternatives exist (FDA, EMA 2018)
Нотатки
Standard antibacterial prophylaxis in high-risk febrile neutropenia per IDSA / NCCN: anticipated ANC <100/µL ≥7 days (HSCT conditioning, AML induction, high-dose chemo for relapsed leukemia/lymphoma). Started day of conditioning / induction, continued through ANC recovery (>500/µL or marrow recovery). The Gram-positive enhancement vs ciprofloxacin (esp. viridans streptococcal mucositis-bacteremia prevention) is the rationale. Trade-offs: selects fluoroquinolone- resistant organisms over time (rising rates of ciprofloxacin/ levofloxacin-resistant E. coli and viridans streptococci limit benefit at some centers — local antibiogram critical); does NOT prevent invasive fungal infection (separate antifungal prophylaxis required — posaconazole, fluconazole). Standard 750 mg dose for pneumonia + Pseudomonas; 500 mg sufficient for FN prophylaxis. Diabetes: severe / fatal hypoglycemia signal — stricter monitoring. Class-wide FDA / EMA 2018 warning: avoid in uncomplicated infections. Ukraine: NSZU-covered for hematology prophylaxis indications; widely available.
Де використовується
У YAML-корпусі не знайдено зворотних посилань.