Snapshot
- A 44-year-old man presents to the emergency department for intractable seizures. He was sedated, intubated, and admitted to the intensive care unit. He remained intubated and on a ventilator due to difficulty weaning sedation in the setting of recurring seizures. After a few days of admission, he developed a fever and an increase in oxygen requirement. A chest radiograph demonstrated a new lung infiltrate and leukocytosis was noted on a complete blood count. He has never been hospitalized in the past and was otherwise healthy. Blood and respiratory cultures are obtained and he is started on intravenous levofloxacin. (Ventilator-associated pneumonia)
Introduction
- Mechanism of action
- a prokaryotic topoisomerase II (DNA gyrase) and IV inhibitor, which directly inhibits DNA synthesis
- Mechanism of resistance
- altered DNA gyrase and topoisomerase IV
- synthesis of membrane efflux pumps
- Clinical use
- gram-negative rods (in the urinary and gastrointestinal tracts)
- otitis externa
- Adverse effects
- gastrointestinal upset
- QT prolongation
- contraindicated in pregnancy, nursing mothers, and < 18 years of age
- secondary to possible cartilage damage