Levofloxacin
Prescription ·Exploratory record · not publication-reviewed ·Updated July 13, 2026
A third-generation (respiratory) fluoroquinolone with broad-spectrum activity against gram-positive (including S. pneumoniae), gram-negative, and atypical organisms. Often called a 'respiratory fluoroquinolone' due to reliable pneumococcal activity. Used for community-acquired pneumonia, hospital-acquired pneumonia, acute bacterial sinusitis, chronic bacterial prostatitis, complicated UTI, and skin infections. Reserved for conditions without safer alternatives due to FDA black box warnings.
Exploratory record, not a reviewed medical publication.
See the editorial and medical-review policies for the publication gate.
This generated database record has not completed a claim-level review by a qualified human medical reviewer. Bibliography links and evidence labels are not approval. The page remains available for reference and is excluded from search indexing.
What the research says.
A quick, data-only summary. The full evidence, dosing, and sources are below.
A third-generation (respiratory) fluoroquinolone with broad-spectrum activity against gram-positive (including S. NutriStack rates the supporting evidence as strong. Common adult dosing is 250-750 mg once daily; CAP: 500 mg daily x 7-14 days or 750 mg daily x 5 days; UTI: 250-750 mg daily (as prescribed by your physician), though a prescriber sets the actual dose. With long-term use it can deplete magnesium. This profile indexes 10 sources.
The bottom line
Evidence rating strong. Most-documented uses: treats community-acquired pneumonia (including drug-resistant s. pneumoniae), treats acute bacterial sinusitis, treats complicated urinary tract infections. 10 sources indexed (2006–2026), with 0 interaction records on file.
How it works, mechanistically.
Core mechanism
The L-isomer of ofloxacin, approximately twice as potent. Inhibits bacterial DNA gyrase (topoisomerase II) and topoisomerase IV, trapping the enzyme-DNA complex and causing lethal double-stranded DNA breaks. Has enhanced activity against gram-positive organisms (particularly S. pneumoniae) compared to ciprofloxacin, making it effective for respiratory infections. Exhibits concentration-dependent bactericidal activity.
Dosing & protocol.
Oral bioavailability approximately 99%. Do NOT take with calcium, iron, magnesium, zinc, or aluminum-containing antacids, chelation reduces absorption by up to 90%. Separate from antacids, sucralfate, and mineral supplements by at least 2 hours before or 2 hours after dosing.5
What it depletes.
Nutrients this medication can lower over time, and what to replace.
Magnesium
ModerateFluoroquinolones can increase renal magnesium wasting and can also bind supplemental magnesium in the gut during active treatment.
Full safety detail.
Side effects
- Nausea and diarrhea
- Tendinitis and tendon rupture (black box warning)
- Peripheral neuropathy (potentially irreversible)
- CNS effects (dizziness, insomnia, headache, seizures)
- QT prolongation
- Dysglycemia (hypoglycemia, hyperglycemia)
- Photosensitivity
- Clostridioides difficile-associated diarrhea
Contraindications
- Known hypersensitivity to levofloxacin or any fluoroquinolone1,2
- Myasthenia gravis (may cause fatal respiratory failure)
- History of tendon disorders related to fluoroquinolone use
- Children under 18 (except for specific indications)6,10
- Known QT prolongation or concurrent use of class IA/III antiarrhythmics
- Known aortic aneurysm or high risk for aortic dissection
Sources, by evidence tier.
Numbered references. Citations throughout the page link here.
Meta-analyses & systematic reviews
4- 1Population pharmacokinetics of levofloxacin: a systematic reviewPMIDDing Y, Zeng X, Zou J et al. · Drug metabolism reviews · 2026
Ding Y, Zeng X, Zou J et al.. Population pharmacokinetics of levofloxacin: a systematic review. Drug metabolism reviews. 2026
- 2A Meta-Analysis of Levofloxacin for Contacts of Multidrug-Resistant TuberculosisPMIDDuong T, Brigden J, Simon Schaaf H et al. · NEJM evidence · 2025
Duong T, Brigden J, Simon Schaaf H et al.. A Meta-Analysis of Levofloxacin for Contacts of Multidrug-Resistant Tuberculosis. NEJM evidence. 2025
- 3A systematic review and meta-analysis of levofloxacin and ciprofloxacin in the treatment of urinary tract infectionPMIDXue Z, Xiang Y, Li Y et al. · Annals of palliative medicine · 2021
Xue Z, Xiang Y, Li Y et al.. A systematic review and meta-analysis of levofloxacin and ciprofloxacin in the treatment of urinary tract infection. Annals of palliative medicine. 2021
- 4Systematic review and meta-analysis: levofloxacin-based rescue regimens after Helicobacter pylori treatment failurePMIDGisbert JP, Morena F · Alimentary pharmacology & therapeutics · 2006
Gisbert JP, Morena F. Systematic review and meta-analysis: levofloxacin-based rescue regimens after Helicobacter pylori treatment failure. Alimentary pharmacology & therapeutics. 2006
Randomized controlled trials
1- 5Efficacy and Safety of Higher Doses of Levofloxacin for Multidrug-resistant Tuberculosis: A Randomized, Placebo-controlled Phase II Clinical TrialPMIDPhillips PPJ, Peloquin CA, Sterling TR et al. · American journal of respiratory and critical care medicine · 2025
Phillips PPJ, Peloquin CA, Sterling TR et al.. Efficacy and Safety of Higher Doses of Levofloxacin for Multidrug-resistant Tuberculosis: A Randomized, Placebo-controlled Phase II Clinical Trial. American journal of respiratory and critical care medicine. 2025
Reviews & position papers
1- 6A retrospective study of the efficacy and safety of levofloxacin in children with severe infectionPMIDJunqi Z, Jie C, Jinglin W et al. · Frontiers in pediatrics · 2024
Junqi Z, Jie C, Jinglin W et al.. A retrospective study of the efficacy and safety of levofloxacin in children with severe infection. Frontiers in pediatrics. 2024
Reference material
4- 7Mandell LA et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007.Source linkedPMID
- 8Etminan M et al. Oral fluoroquinolones and the risk of retinal detachment. JAMA. 2012.Source linkedPMID
- 9FDA Drug Safety Communication: FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics. FDA. 2018.Source linkedPMID
- 10Hesseling AC, Purchase SE, Martinson NA et al.. Levofloxacin Preventive Treatment in Children Exposed to MDR Tuberculosis. The New England journal of medicine. 2024Source linkedPMID
Common questions.
Quick answers about Levofloxacin, drawn from the data on this page.
What is Levofloxacin?
A third-generation (respiratory) fluoroquinolone with broad-spectrum activity against gram-positive (including S. pneumoniae), gram-negative, and atypical organisms. Often called a 'respiratory fluoroquinolone' due to reliable pneumococcal activity. Used for community-acquired pneumonia, hospital-acquired pneumonia, acute bacterial sinusitis, chronic bacterial prostatitis, complicated UTI, and skin infections. Reserved for conditions without safer alternatives due to FDA black box warnings.
What is Levofloxacin used for?
Commonly cited benefits of Levofloxacin include: Treats community-acquired pneumonia (including drug-resistant S. pneumoniae); Treats acute bacterial sinusitis; Treats complicated urinary tract infections; Treats chronic bacterial prostatitis; Treats hospital-acquired/ventilator-associated pneumonia. NutriStack rates the overall evidence as strong.
What is a typical dose of Levofloxacin?
A typical adult dose of Levofloxacin is 250-750 mg once daily; CAP: 500 mg daily x 7-14 days or 750 mg daily x 5 days; UTI: 250-750 mg daily (as prescribed by your physician). The commonly recommended form is Oral tablets, oral solution, or IV. These are general ranges, not personalized advice; confirm the right dose with a clinician.
What are the side effects of Levofloxacin?
Reported side effects include nausea and diarrhea, tendinitis and tendon rupture (black box warning), peripheral neuropathy (potentially irreversible), cns effects (dizziness, insomnia, headache, seizures), qt prolongation, dysglycemia (hypoglycemia, hyperglycemia). This is educational information; check with a healthcare professional before use.
How strong is the evidence for Levofloxacin?
NutriStack rates this as Strong, meaning multiple high-quality meta-analyses or systematic reviews converge on the same finding. Full tier criteria are at https://nutristackapp.com/methodology/evidence-tiers.
Use this with your stack
Levofloxacin in NutriStack.
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