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Levaquin, Levofloxacin Systemic levofloxacin dosing, 500 mg PO/IV once daily for 10-14 days or 750 mg PO/IV once daily for 5 days Limitations-of-use: Reserve fluoroquinolones for patients who do not have other available treatment options for acute sinusitis Indicated for treatment and prophylaxis of plague, including pneumonic and septicemic plague, caused by Yersinia pestis in adults and pediatric patients, aged 6 months or older 500 mg PO/IV once daily for 10-14 days Nausea (7%) Headache (6%) Diarrhea (5%) Insomnia (4%) Constipation (3%) Dizziness (3%) Dyspepsia (2%) Rash (2%) Vomiting (2%) Chest pain (1%) Dyspnea (1%) Edema (1%) Fatue (1%) Injection-site reaction (1%) Moniliasis (1%) Pain (1%) Pruritus (1%) Vaginitis (1%) Cardiac: Cardiac arrest, palpitation, ventricular tachycardia, arrhythmia Nervous system: Tremor, convulsions, paresthesia, verto, hypertonia, hyperkinesias, abnormal gait, somnolence, syncope Metabolic: Hypoglycemia, hyperglycemia, hyperkalemia Blood/lymphatic system: Anemia, thrombocytopenia, granulocytopenia Musculoskeletal/connective tissue: Arthralgia, tendonitis, myalgia, skeletal pain Gastrointestinal (GI): Gastritis, stomatitis, pancreatitis, esophagitis, gastroenteritis, glossitis, pseudomembranous/C difficile colitis Hepatobiliary: Abnormal hepatic function, increased hepatic enzymes, increased alkaline phosphatase Psychiatric: Anxiety, agitation, confusion, depression, hallucinations, nhtmares, sleep disorder, anorexia, abnormal dreaming Other: Immune hypersensitivity reaction, acute renal failure, urticaria, pebitis, epistaxis Cardiac: Prolonged QT interval, torsades de pointes, tachycardia Musculoskeletal/connective tissue: Tendon rupture, muscle injury, rhabdomyolysis Skin/subcutaneous tissue: Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, photosensitivity/phototoxicity, leukocytoclastic vasculitis Renal and urinary disorders: Interstitial nephritis Vascular disorders: Vasodilation Blood/lymphatic system: Pancytopenia, aplastic anemia, leukopenia, hemolytic anemia, eosinophilia Hepatobiliary: Hepatic failure, hepatitis, jaundice Psychiatric: Psychosis, paranoia, suicidal ideation, isolated reports of suicide attempts Nervous system: Exacerbation of myasthenia gravis, anosmia, ageusia, parosmia, dysgeusia, peripheral neuropathy, abnormal electroencephalogram (EEG), dysphonia, isolated reports of encephalopathy, pseudotumor cerebri Central nervous system effects (hallucinations, anxiety, depression, insomnia, severe headaches, and confusion) Respiratory, thoracic and mediastinal disorders: Isolated reports of allergic pneumonitis Immune system disorders: Hypersensitivity reactions, sometimes fatal including: anaphylactic/anaphylactoid reactions, anaphylactic shock, angioneurotic edema, serum sickness Eye disorders: Uveitis, vision disturbance (including diplopia), visual acuity reduced, vision blurred, scotoma Otologic: Hypoacusis, tinnitus General disorders and administration site conditions: Multiorgan failure, pyrexia Fluoroquinolones have been associated with disabling and potentially irreversible serious adverse reactions that have occurred together including: tendinitis and tendon rupture, peripheral neuropathy, and CNS effects Discontinue the drug immediately and avoid use of systemic fluoroquinolones in patients who experience any of these serious adverse reactions May exacerbate muscle weakness in patients with myasthenia gravis; fluoroquinolones should be avoided in patients with known history of myasthenia gravis Anaphylactic reactions and allergic skin reactions, serious, occasionally fatal, may occur after first dose Use caution in hematologic and renal toxicities Hepatotoxicity reported with therapy Peripheral neuropathy: Sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias, and weakness reported; peripheral neuropathy may occur rapidly after initiating and may potentially become permanent Central nervous system (CNS) effects, including toxic psychosis, convulsions, increased intracranial pressure (pseudotumor cerebri), anxiety, confusion, depression, and insomnia reported with therapy Commonly seen adverse reactions include tendinitis, tendon rupture, arthralgia, myalgia, peripheral neuropathy, and central nervous system effects (hallucinations, anxiety, depression, insomnia, severe headaches, and confusion); these reactions can occur within hours to weeks after starting therapy, including in patients of any age or without pre-existing risk factors; discontinue therapy immediately at first sns or symptoms of any serious adverse reaction; in addition, avoid use of fluoroquinolones, in patients who have experienced any serious adverse reactions associated with fluoroquinolones Risk of developing fluoroquinolone-associated tendinitis and tendon rupture is increased in patients over 60 years of age, in patients taking corticosteroid drugs, and in patients with kidney, heart or lung transplants; other factors that may independently increase risk of tendon rupture include strenuous physical activity, renal failure, and previous tendon disorders such as rheumatoid arthritis Use with caution in patients with known or suspected disorders that predispose to seizures or take medications that will lower seizure threshold May increase risk of tendon rupture in aptients with rheumatoid arthritis; use caution Excessive sunlht may result in moderate-to-severe phototoxicity Fatal hypoglycemia reported in elderly patients with or without diabetes; prompt treatment when symptoms are present is essential May cause C difficile-associated colitis Prolonged use may result in fungal or bacterial superinfection Prolongation of QT interval and isolated cases of torsades de pointes; avoid use in patients with known QT prolongation, those with hypokalemia, and those taking other QT-prolonging drugs May produce false-positive urine opiate screens No longer recommended for gonorrhea in United States, because of widespread resistance In prolonged therapy, perform periodic evaluations of organ system function (eg, renal, hepatic, hematopoietic); adjust dosage in renal impairment; superinfections may occur with prolonged or repeated antibiotic therapy Pediatric patients may experience increased incidence of musculoskeletal disorders (eg, arthralgia, arthritis, tendinopathy, gait abnormality) Acute onset of retinal detachment increased 4.5-fold with oral fluoroquinolones in a single case-controlled study - JAMA 2012;307(13):1414-1419; another study disputes these findings (relative risk, 1.29) - JAMA 2013;310(20):2184-2190 Clostridium difficile-associated diarrhea (CDAD) has been reported; if CDAD suspected or confirmed, ongoing antibiotic use not directed against C. 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