Levofloxacin

What it is

Levofloxacin is a synthetic antibacterial drug, the levo-rotatory single enantiomer of ofloxacin, and a member of the fluoroquinolone class. The U.S. label places it in that class and points to the microbiology section for how it works. It is supplied as tablets, an oral solution and an intravenous infusion; the oral solution label describes 250 mg, 500 mg and 750 mg strengths taken once every 24 hours. It is prescription-only.

What the research says

Levofloxacin kills bacteria, and for several respiratory and urinary infections trial evidence is consistent with benefit, though a 2024 network meta-analysis of oral antibiotics for mild-to-moderate community-acquired pneumonia found no antibiotic clearly better than another. The larger story in the literature is harm: cohort and case-control studies and the drug's own boxed warning link fluoroquinolones to tendon rupture, peripheral neuropathy and central nervous system effects, and regulators have restricted its use in infections that often resolve on their own. The aortic aneurysm signal is genuinely contested, with a large 2025 multinational cohort finding no increase and a 2026 meta-analysis of cohort studies finding one.

Evidence grade: Well established.

How it works

Drug class: Fluoroquinolone antibacterial (bacterial DNA gyrase / topoisomerase IV inhibitor class)

Levofloxacin belongs to the fluoroquinolone family of antibacterial drugs. Fluoroquinolones kill bacteria by blocking the bacterial enzymes that unwind and re-seal DNA, so the bacterium cannot copy its own genetic material. The U.S. label itself says only that levofloxacin is a member of the fluoroquinolone class and refers the reader to its microbiology section, so this monograph records the class attribution rather than a mechanism the label spells out. (Source 1)

Boxed warning

WARNING: SERIOUS ADVERSE REACTIONS INCLUDING TENDINITIS, TENDON RUPTURE, PERIPHERAL NEUROPATHY, CENTRAL NERVOUS SYSTEM EFFECTS AND EXACERBATION OF MYASTHENIA GRAVIS

(Source 2)

What it is used for

• A network meta-analysis of 24 randomised trials in 9,361 adults ranked levofloxacin among the regimens most likely to achieve clinical response and lower mortality, but the authors found no conclusive evidence that any antibiotic was clearly better than another and all confidence intervals were broad and overlapping. Half the included trials were at high risk of bias. Evidence: limited. (Source 3)
• Levofloxacin remains approved for uncomplicated urinary tract infection, but the label itself says the use should be reserved for people with no alternative, because serious adverse reactions have been linked to fluoroquinolones and the infection is often self-limiting. A cohort of 954,777 women found tendon rupture 25% more likely with a fluoroquinolone than with trimethoprim-sulfamethoxazole. Evidence: disputed. (Source 4)
• Both remain approved indications, but the boxed warning instructs that levofloxacin be reserved for patients who have no alternative treatment options for these two conditions and for uncomplicated urinary tract infection, because of the disabling adverse reactions associated with the class. Evidence: disputed. (Source 2)
• In a placebo-controlled trial of 977 patients (TEAMM), 12 weeks of levofloxacin reduced first febrile episodes or death from 134 of 488 (27%) on placebo to 95 of 489 (19%), a hazard ratio of 0.66. That is an absolute difference of about 8 percentage points, roughly one event avoided for every 13 people treated for 12 weeks; five episodes of mostly reversible tendonitis occurred in the levofloxacin arm. Evidence: limited. (Source 5)
• Two placebo-controlled randomised trials published together in 2024 both found fewer tuberculosis cases on levofloxacin but neither reached statistical significance: 0.6% versus 1.1% in Vietnamese household contacts and 1.1% versus 2.6% in South African children. Adverse events of any grade were far commoner on levofloxacin in the adult trial, 31.9% versus 13.0%. Evidence: not-supported. (Source 6)

Interactions

• Magnesium- or aluminium-containing antacids, sucralfate, iron, and multivitamins containing zinc (label): These bind levofloxacin in the gut so that much less of it reaches the bloodstream. The label says the resulting levels are considerably lower than desired and that these products should be separated from the dose by at least two hours. (Source 7)
• Mineral supplements and antacids generally (pharmacokinetic evidence) (pharmacokinetic study): A systematic review with meta-analyses of quinolone food and supplement interactions found that every quinolone it could analyse lost substantial bioavailability when given with antacids or mineral supplements, with calcium preparations the exception. The reviewers rated the overall quality of this evidence as low. (Source 8)
• Milk and calcium-fortified orange juice (pharmacokinetic study): The same review found that both ciprofloxacin and levofloxacin had reduced bioavailability when taken with orange juice, particularly calcium-fortified orange juice, and that half the quinolones studied absorbed significantly less in the presence of milk. (Source 8)
• Alcohol (theoretical): We found no human pharmacokinetic evidence for a levofloxacin-alcohol interaction. The largest systematic review of quinolone dietary interactions explicitly excluded studies involving alcohol, so the question was not examined there and this monograph records no evidence rather than no interaction. (Source 9)
• Insulin and oral glucose-lowering drugs such as glyburide (clinical trial): Blood sugar can swing in either direction. The label reports symptomatic hyperglycaemia and hypoglycaemia, usually in people with diabetes on these drugs, and a Taiwanese cohort found levofloxacin users had about 1.8 times the odds of a hospital visit for either compared with macrolide users. (Source 10)
• Class IA and Class III antiarrhythmic drugs (quinidine, procainamide, amiodarone, sotalol) and uncorrected low potassium (label): Levofloxacin can lengthen the QT interval on the electrocardiogram, and the label says it should be avoided in people with known QT prolongation, uncorrected low potassium, or on these antiarrhythmic drugs. (Source 11)

Stopping it

• Levofloxacin is not a drug of dependence and the literature we searched describes no withdrawal syndrome. The stopping instruction in the label runs the other way: it tells prescribers to stop the drug immediately at the first sign of a serious adverse reaction and never to use a fluoroquinolone again in that person. (Source 12)
• Stopping does not reliably undo the harm. The label states that some of these reactions can occur together in the same patient, within hours to weeks of starting, in people of any age and without pre-existing risk factors, and that they are potentially irreversible. (Source 12)
• For peripheral neuropathy specifically, the label instructs immediate discontinuation on symptoms and permanent avoidance of fluoroquinolones afterwards. (Source 13)

What goes wrong

In a nationwide Taiwanese claims cohort, fluoroquinolone exposure was associated with about twice the incidence of tendon disorders, on an absolute scale of a few cases per 100,000 person-years. (Source 14)

• Cohort study, Low certainty.
• Size: nationwide claims database covering more than 99% of the Taiwanese population.
• Who: patients exposed to a fluoroquinolone for more than three consecutive days, matched to unexposed controls by age, sex and index year.
• How long: study period January 2000 to December 2015; median follow-up 11.05 years.
• Result: 6.61 versus 3.34 tendon disorders per 100,000 person-years (the source writes this as per 10⁵ person-years); adjusted hazard ratio 1.423, 95% CI 1.02 to 1.87, p = 0.021.
• Funding: not stated.

Limit of this finding: The rates in this quotation are per 100,000 person-years. The paper prints the denominator as the number 10 with a small raised 5 beside it, which means 100,000; read as a plain "105" the rates would look about 950 times larger than they are. In everyday terms about 7 people in every 100,000 taking a fluoroquinolone for a year developed a tendon problem against about 3 in every 100,000 who did not. This is a claims-database comparison, not a trial, so it shows an association and cannot show that the drug caused the tendon problems; the list of higher-risk groups at the end of the quotation comes from subgroup analyses of the same database.

Results: The incidence of tendon disorders were 6.61 and 3.34 per 10⁵ person-years in patients with and without fluoroquinolone exposure, respectively (adjusted hazard ratio, 1.423; 95% confidence interval [1.02,1.87]; p = 0.021). Sensitivity analyses yielded similar results.

After short fluoroquinolone courses for uncomplicated urinary tract infection, tendon rupture was 25% more likely than with trimethoprim-sulfamethoxazole, while neurological events were not increased relative to nitrofurantoin. (Source 15)

• Cohort study, Low certainty.
• Size: 954,777 female outpatients.
• Who: female outpatients in a United States claims database treated for uncomplicated urinary tract infection, December 2009 to 2019.
• How long: short-course treatment; adjusted absolute risks from Kaplan-Meier cumulative hazards.
• Result: adjusted absolute risk range for collagen/neurological events <1%-4.5%; tendon rupture hazard ratio 1.25, 95% CI 1.00-1.57, P = 0.0497; lower hazard of central nervous system events versus nitrofurantoin, 0.85, 95% CI 0.80-0.89.
• Funding: industry-funded (first author affiliated with GSK; Research Support, Non-U.S. Gov't)

Limit of this finding: Two things in this source do not add up and both are the paper’s own. The three treatment groups it lists (386,537 + 237,120 + 314,585) come to 938,242, not the 954,777 total it states, so about 16,500 people, 1.8 per cent, are unaccounted for in the abstract; and the percentages it gives sum to 98.2 per cent. The tendon-rupture result is also right on the edge of statistical significance: the lower end of its confidence interval is exactly 1.00 and the p value is 0.0497. A reader should take this as a weak signal, not a firm effect. The cohort is female outpatients only, drawn from United States commercial insurance claims and analysed with weighted modelling, so it does not describe men or hospital patients.

Adjusted absolute risk range for collagen/neurological AESIs was <1%-4.5%. The hazard (95% CI) of tendon rupture was 25% higher with FQ versus SXT (1.25 [1.00-1.57]; P = 0.0497). Patients receiving FQ had lower hazard of neurological (0.95 [0.93-0.97]; P < 0.0001), central nervous system (0.85 [0.80-0.89]; P < 0.0001), and peripheral nervous system (0.96 [0.93-0.98]; P = 0.0016) AESIs versus NTF.

In a propensity-matched cohort of nearly two million people, fluoroquinolone use was associated with a small increase in diagnosed neurological dysfunction. (Source 16)

• Cohort study, Low certainty.
• Size: 976,568 fluoroquinolone-exposed individuals matched 1:1 with a comparator antibiotic.
• Who: insured United States adults prescribed an oral fluoroquinolone or comparator antibiotic for sinusitis, bronchitis exacerbation, uncomplicated urinary tract infection or acute bronchitis, 2000-2015.
• How long: not stated in the abstract.
• Result: hazard ratio 1.08, 95% CI 1.05-1.11 for central nervous system dysfunction; 1.09, 95% CI 1.07-1.11 for the commonest peripheral nervous system outcome.
• Funding: Research Support, N.I.H., Extramural (independent of industry)

Our cohort contained 976 568 individuals exposed to a fluoroquinolone antibiotic matched 1:1 with a comparator. Matching produced balance (standardized mean difference <0.1) on all variables included in the propensity score. The hazard ratio associated with fluoroquinolone exposure was 1.08 (95% confidence interval 1.05-1.11) for CNS dysfunction, and 1.09 (95% CI 1.07-1.11) for the most commonly occurring PNS dysfunction outcome.

In diabetic patients, oral levofloxacin was associated with a higher risk of emergency-department visits or hospitalisation for both hyperglycaemia and hypoglycaemia than macrolides. (Source 17)

• Cohort study, Low certainty.
• Size: 78,433 diabetic patients.
• Who: Taiwanese outpatients with diabetes starting levofloxacin, ciprofloxacin, moxifloxacin, cephalosporins or macrolides, 2006-2007.
• How long: events within 30 days of starting antibiotic therapy.
• Result: absolute risk of hyperglycaemia per 1000 persons 6.9 for moxifloxacin versus 1.6 for macrolides; hypoglycaemia 10.0 versus 3.7; levofloxacin adjusted odds ratio 1.75, 95% CI 1.12-2.73 for hyperglycaemia and 1.79, 95% CI 1.33-2.42 for hypoglycaemia.
• Funding: Research Support, Non-U.S. Gov't.

A total of 78 433 diabetic patients receiving the antibiotics of interest were included in the study. The absolute risk of hyperglycemia per 1000 persons was 6.9 for moxifloxacin and 1.6 for macrolides. In contrast, the risk of hypoglycemia was 10.0 for moxifloxacin and 3.7 for macrolides. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) of levofloxacin, ciprofloxacin, and moxifloxacin compared with macrolides were 1.75 (1.12-2.73), 1.87 (1.20-2.93), and 2.48 (1.50-4.12), respectively, for hyperglycemia and 1.79 (1.33-2.42), 1.46 (1.07-2.00), and 2.13 (1.44-3.14), respectively, for hypoglycemia.

A 2026 meta-analysis of 11 cohort studies found fluoroquinolone use associated with aortic aneurysm or dissection, concentrated in the first 90 days. (Source 18)

• Meta-analysis, Low certainty.
• Size: 11 studies with 81,976,958 participants.
• Who: cohort studies of fluoroquinolone users.
• How long: risk windows of 90 days and 365 days analysed separately.
• Result: HR 1.20, 95% CI 1.06-1.35 for aortic aneurysm or dissection; 1.47, 95% CI 1.24-1.73 for aneurysm; within 90 days HR 1.20, 95% CI 1.13-1.26; no increase at 365 days or more, HR 1.00, 95% CI 0.90-1.12.
• Funding: not stated.

Limit of this finding: This is a pooled result from eleven observational cohort studies, so it shows an association between fluoroquinolone use and aortic aneurysm or dissection and cannot show that the drugs caused it. The male and female figures are each a comparison against non-users, not a test of whether men are at higher risk than women, and their intervals overlap heavily. The word "Conclusion" runs straight into the following word in this record, with no space; that is how PubMed flattens the publisher’s section heading and it has been kept rather than edited out.

11 studies were included, with 81,976,958 participants. The risk of AA/AD among FQs users was found to be elevated (HR = 1.20, 95% CI: 1.06-1.35). Similar results were found for AA (HR = 1.47, 95% CI: 1.24-1.73) and AD (HR = 1.12, 95% CI: 1.04-1.22). In subgroup analysis, the gender subgroup analysis revealed a higher risk of AA/AD for males (HR = 1.16, 95% CI: 1.06-1.27) compared to females (HR = 1.09, 95% CI: 1.00-1.20). Regionally, the risk was higher in America (HR = 1.47, 95% CI: 1.12-1.93) than Europe (HR = 1.08, 95% CI: 0.98-1.19) and Asia (HR = 0.80, 95% CI: 0.61-1.05). Risk associated with FQs use within 90 days (HR = 1.20, 95% CI: 1.13-1.26) was significantly higher, while no significant increase was observed for ≥365 days (HR = 1.00, 95% CI: 0.90-1.12).

A systematic review and meta-analysis to 2020 found only a modest association between fluoroquinolones and healthcare facility-associated Clostridioides difficile infection, weaker than for carbapenems or later cephalosporins. (Source 19)

• Systematic review, Low certainty.
• Size: studies of adult hospital inpatients published 2013-2020, pooled by random effects.
• Who: adult hospital inpatients with measured exposure to individual antibiotics or antibiotic classes.
• How long: not stated in the abstract.
• Result: carbapenems and third- and fourth-generation cephalosporins most strongly associated, cases more than twice as likely to have had recent exposure; modest associations for fluoroquinolones, clindamycin and beta-lactamase inhibitor combination penicillins; heterogeneity observed for most classes.
• Funding: not stated.

Limit of this finding: This review pooled observational studies, not trials, so it shows which antibiotics people with Clostridioides difficile infection had recently taken, not that the antibiotics caused it. It also reports no pooled number for fluoroquinolones: there is no odds ratio, no confidence interval and no p value anywhere in the result, only the authors’ plain-language description of a modest association. The authors add that individual study results varied and that heterogeneity was seen for most antibiotic classes, so no single figure should be attached to this reference.

Carbapenems and third- and fourth-generation cephalosporin antibiotics remain the most strongly associated with HCFA-CDI, with cases more than twice as likely to have recent exposure to these antibiotics prior to developing HCFA-CDI. Modest associations were observed for fluoroquinolones, clindamycin and β-lactamase inhibitor combination penicillin antibiotics. Individual study effect sizes were variable and heterogeneity was observed for most antibiotic classes.

In pooled Phase 3 trials, 4.3% of levofloxacin-treated patients stopped the drug because of adverse reactions, and the commonest adverse reactions were gastrointestinal and neurological. (Source 20)

• Official position, Moderate certainty.
• Size: 7,537 patients in 29 pooled Phase 3 clinical trials.
• Who: patients with a wide variety of infectious diseases, mean age 50, treated with 250 mg, 500 mg or 750 mg once daily or 500 mg twice daily.
• How long: usually 3-14 days, mean 10 days.
• Result: discontinuation 4.3% overall, 3.8% at 250-500 mg and 5.4% at 750 mg; commonest adverse drug reactions at 3% or more are nausea, headache, diarrhoea, insomnia, constipation and dizziness.
• Funding: manufacturer's label (position of the sponsor and FDA, SPL effective 2025-09-01)

Discontinuation of levofloxacin due to adverse drug reactions occurred in 4.3% of patients overall, 3.8% of patients treated with the 250 mg and 500 mg doses and 5.4% of patients treated with the 750 mg dose. The most common adverse drug reactions leading to discontinuation with the 250 and 500 mg doses were gastrointestinal (1.4%), primarily nausea (0.6%); vomiting (0.4%); dizziness (0.3%); and headache (0.2%). The most common adverse drug reactions leading to discontinuation with the 750 mg dose were gastrointestinal (1.2%), primarily nausea (0.6%), vomiting (0.5%); dizziness (0.3%); and headache (0.3%). Adverse reactions occurring in ≥ 1% of levofloxacin-treated patients and less common adverse reactions, occurring in 0.1 to <1% of levofloxacin-treated patients, are shown in Table 4 and Table 5, respectively. The most common adverse drug reactions (≥ 3%) are nausea, headache, diarrhea, insomnia, constipation, and dizziness.

The label states that tendinitis and tendon rupture can occur bilaterally, as late as several months after therapy ends, and in people with no risk factors. (Source 21)

• Official position, Certainty not rated.
• Size: not stated.
• Who: all ages.
• How long: within hours or days of starting, or as long as several months after completion of therapy.
• Result: no rate given in this section; risk increased over 60 years of age, on corticosteroids, and after kidney, heart or lung transplant.
• Funding: manufacturer's label (position of the sponsor and FDA, SPL effective 2025-09-01)

Tendinitis or tendon rupture can occur within hours or days of starting levofloxacin or as long as several months after completion of fluoroquinolone therapy. Tendinitis and tendon rupture can occur bilaterally. The risk of developing fluoroquinolone-associated tendinitis and tendon rupture is increased in patients over 60 years of age, in those taking corticosteroid drugs, and in patients with kidney, heart or lung transplants. Other factors that may independently increase the risk of tendon rupture include strenuous physical activity, renal failure, and previous tendon disorders such as rheumatoid arthritis. Tendinitis and tendon rupture have been reported in patients taking fluoroquinolones who do not have the above risk factors.

The label states that peripheral neuropathy may begin soon after starting levofloxacin and may be irreversible. (Source 13)

• Official position, Certainty not rated.
• Size: not stated.
• Who: patients receiving fluoroquinolones including levofloxacin.
• How long: symptoms may occur soon after initiation.
• Result: no rate given; sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons.
• Funding: manufacturer's label (position of the sponsor and FDA, SPL effective 2025-09-01)

Cases of sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias and weakness have been reported in patients receiving fluoroquinolones, including levofloxacin. Symptoms may occur soon after initiation of levofloxacin and may be irreversible in some patients

The label records an epidemiological signal for aortic aneurysm and dissection within two months of fluoroquinolone use and says the cause has not been identified. (Source 22)

• Official position, Certainty not rated.
• Size: not stated.
• Who: fluoroquinolone users, particularly elderly patients.
• How long: within two months following use.
• Result: no rate given in the label section.
• Funding: manufacturer's label (position of the sponsor and FDA, SPL effective 2025-09-01)

Epidemiologic studies report an increased rate of aortic aneurysm and dissection within two months following use of fluoroquinolones, particularly in elderly patients. The cause for the increased risk has not been identified.

The label warns that Clostridium difficile-associated diarrhoea can range from mild diarrhoea to fatal colitis and has been reported more than two months after antibiotic use. (Source 23)

• Official position, Certainty not rated.
• Size: not stated.
• Who: patients taking nearly all antibacterial agents, including levofloxacin.
• How long: reported to occur over two months after administration.
• Result: no rate given; hypertoxin producing strains cause increased morbidity and mortality and may require colectomy.
• Funding: manufacturer's label (position of the sponsor and FDA, SPL effective 2025-09-01)

Clostridium difficile-associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including levofloxacin, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile. C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.

The label records QT prolongation and rare postmarketing reports of torsade de pointes, and lists the people in whom levofloxacin should be avoided for that reason. (Source 11)

• Official position, Certainty not rated.
• Size: not stated.
• Who: patients receiving fluoroquinolones including levofloxacin; elderly patients may be more susceptible.
• How long: not stated.
• Result: infrequent cases of arrhythmia; rare spontaneously reported cases of torsade de pointes in postmarketing surveillance.
• Funding: manufacturer's label (position of the sponsor and FDA, SPL effective 2025-09-01)

Rare cases of torsade de pointes have been spontaneously reported during postmarketing surveillance in patients receiving fluoroquinolones, including levofloxacin. Levofloxacin should be avoided in patients with known prolongation of the QT interval, patients with uncorrected hypokalemia, and patients receiving Class IA (quinidine, procainamide), or Class III (amiodarone, sotalol) antiarrhythmic agents.

The label records symptomatic hyperglycaemia and hypoglycaemia with levofloxacin, usually in people with diabetes also taking an oral hypoglycaemic agent or insulin. (Source 10)

• Official position, Certainty not rated.
• Size: not stated.
• Who: usually diabetic patients on concomitant glucose-lowering treatment.
• How long: not stated.
• Result: no rate given in this section; instruction to discontinue levofloxacin if a hypoglycaemic reaction occurs.
• Funding: manufacturer's label (position of the sponsor and FDA, SPL effective 2025-09-01)

As with other fluoroquinolones, disturbances of blood glucose, including symptomatic hyper- and hypoglycemia, have been reported with levofloxacin, usually in diabetic patients receiving concomitant treatment with an oral hypoglycemic agent (e.g., glyburide) or with insulin. In these patients, careful monitoring of blood glucose is recommended.

A systematic review with meta-analyses of 109 pharmacokinetic studies found that every quinolone analysed lost substantial bioavailability when taken with antacids or mineral supplements, calcium preparations excepted, and rated the evidence low quality. (Source 8)

• Systematic review, Low certainty.
• Size: 109 studies from 101 reports, covering 22 quinolones.
• Who: human pharmacokinetic studies of orally taken quinolones with food, beverages, antacids and mineral supplements.
• How long: single and repeated dosing studies; search to December 2022.
• Result: all 14 analysed quinolones showed substantial reduction in bioavailability with antacids and mineral supplements except calcium preparations; 46% of studies at high risk of bias, only 4% at low risk; evidence quality judged low.
• Funding: Research Support, Non-U.S. Gov't.

All 14 analysed quinolones showed a substantial reduction in bioavailability when co-administered with antacids and mineral supplements, except for calcium preparations. The impact of beverages was evaluated for 10 quinolones, with 50% experiencing significantly reduced absorption in the presence of milk (the highest negative impact for ciprofloxacin). Moreover, both ciprofloxacin and levofloxacin demonstrated compromised bioavailability when consumed with orange juice, particularly calcium-fortified.

The U.S. label contraindicates levofloxacin in anyone with known hypersensitivity to levofloxacin or to any other quinolone antibacterial. (Source 24)

• Official position, Certainty not rated.
• Size: not applicable - regulatory position.
• Who: all patients.
• How long: not applicable.
• Result: an absolute contraindication; no rate is given in this section.
• Funding: not stated.

Limit of this finding: The cross-reference printed in this sentence is wrong in the label itself. It sends the reader to section 5.3, which is about peripheral neuropathy; hypersensitivity reactions are in section 5.7. The label’s own hyperlink also points at 5.3. The error is the document’s and has been kept exactly as printed, but a reader following that reference will land in the wrong place.

Levofloxacin is contraindicated in persons with known hypersensitivity to levofloxacin, or other quinolone antibacterials [see Warnings and Precautions (5.3)].

The label’s own footnote to the 60-day inhalational anthrax regimens states that the safety of levofloxacin has not been studied beyond 28 days in adults or beyond 14 days in children, and that children on it have shown more musculoskeletal adverse events than controls. (Source 25)

• Official position, Certainty not rated.
• Size: not applicable - regulatory position.
• Who: adults and children aged 6 months and over given prolonged courses.
• How long: beyond 28 days in adults, beyond 14 days in children.
• Result: no rate given; the label states only that an increased incidence of musculoskeletal adverse events compared to controls has been observed in pediatric patients.
• Funding: not stated.

The safety of levofloxacin in adults for durations of therapy beyond 28 days or in pediatric patients for durations beyond 14 days has not been studied. An increased incidence of musculoskeletal adverse events compared to controls has been observed in pediatric patients [see Warnings and Precautions (5.11), Use in Specific Populations (8.4), and Clinical Studies (14.9)]. Prolonged levofloxacin therapy should only be used when the benefit outweighs the risk.

The adverse-reaction rates in the label come from 7,537 patients in 29 pooled Phase 3 trials, in which the commonest reactions at 3 per cent or more were nausea, headache, diarrhoea, insomnia, constipation and dizziness. (Source 20)

• Official position, Certainty not rated.
• Size: 7,537 patients in 29 pooled Phase 3 clinical trials.
• Who: mean age 50 years, about 74% under 65, 50% male, 71% Caucasian, 19% Black, treated for a wide variety of infections.
• How long: usually 3 to 14 days, mean 10 days on therapy.
• Result: Table 4 of the label, N=7537: nausea 7%, headache 6%, diarrhea 5%, insomnia 4% (N=7274), constipation 3%, dizziness 3%, abdominal pain 2%, vomiting 2%, dyspepsia 2%, rash 2%, moniliasis 1%, dyspnea 1%, pruritus 1%, vaginitis 1% (N=3758 women), edema 1%, injection site reaction 1%, chest pain 1%.
• Funding: not stated.

Limit of this finding: These are trial rates, and the label says in the same passage that rates seen in trials cannot be compared directly with another drug’s trials and may not match what happens in practice. The figures are percentages of 7,537 people, except insomnia, which is out of 7,274, and vaginitis, which is out of 3,758 women.

The data described below reflect exposure to levofloxacin in 7537 patients in 29 pooled Phase 3 clinical trials. The population studied had a mean age of 50 years (approximately 74% of the population was < 65 years of age), 50% were male, 71% were Caucasian, 19% were Black. Patients were treated with levofloxacin for a wide variety of infectious diseases [see Indications and Usage ( 1 )]. Patients received levofloxacin doses of 750 mg once daily, 250 mg once daily, or 500 mg once or twice daily. Treatment duration was usually 3–14 days, and the mean number of days on therapy was 10 days. The overall incidence, type and distribution of adverse reactions was similar in patients receiving levofloxacin doses of 750 mg once daily, 250 mg once daily, and 500 mg once or twice daily. Discontinuation of levofloxacin due to adverse drug reactions occurred in 4.3% of patients overall, 3.8% of patients treated with the 250 mg and 500 mg doses and 5.4% of patients treated with the 750 mg dose. The most common adverse drug reactions leading to discontinuation with the 250 and 500 mg doses were gastrointestinal (1.4%), primarily nausea (0.6%); vomiting (0.4%); dizziness (0.3%); and headache (0.2%). The most common adverse drug reactions leading to discontinuation with the 750 mg dose were gastrointestinal (1.2%), primarily nausea (0.6%), vomiting (0.5%); dizziness (0.3%); and headache (0.3%). Adverse reactions occurring in ≥ 1% of levofloxacin-treated patients and less common adverse reactions, occurring in 0.1 to <1% of levofloxacin-treated patients, are shown in Table 4 and Table 5, respectively. The most common adverse drug reactions (≥ 3%) are nausea, headache, diarrhea, insomnia, constipation, and dizziness.

What the evidence supports

Twelve weeks of levofloxacin prophylaxis in newly diagnosed myeloma reduced first febrile episode or death from 27% to 19% against placebo. (Source 5)

• Randomized trial, Moderate certainty.
• Size: 977 patients (489 levofloxacin, 488 placebo) in 93 UK hospitals.
• Who: adults aged 21 and over with newly diagnosed myeloma within 14 days of starting myeloma treatment.
• How long: 12 weeks of treatment, median 12 months follow-up.
• Result: 95/489 (19%) versus 134/488 (27%); hazard ratio 0.66, 95% CI 0.51-0.86, p=0.0018; five episodes (1%) of mostly reversible tendonitis in the levofloxacin group.
• Funding: UK National Institute for Health Research (independent of industry)

Limit of this finding: The source leaves a bracket unclosed in this passage, printing "p=0·0018." with no closing parenthesis, and uses a raised dot rather than a full stop as its decimal point. Both are the journal’s house style and have been kept. The trial was in people newly diagnosed with myeloma receiving anti-myeloma treatment, so it does not describe levofloxacin given for an infection.

95 (19%) first febrile episodes or deaths occurred in 489 patients in the levofloxacin group versus 134 (27%) in 488 patients in the placebo group (hazard ratio 0·66, 95% CI 0·51-0·86; p=0·0018. 597 serious adverse events were reported up to 16 weeks from the start of trial treatment (308 [52%] of which were in the levofloxacin group and 289 [48%] of which were in the placebo group). Serious adverse events were similar between the two groups except for five episodes (1%) of mostly reversible tendonitis in the levofloxacin group.

What the evidence does not support

Levofloxacin preventive treatment in adult household contacts of multidrug-resistant tuberculosis did not significantly reduce confirmed tuberculosis, and caused far more adverse events than placebo. (Source 6)

• Randomized trial, Moderate certainty.
• Size: 2,041 randomised household contacts in Vietnam.
• Who: household contacts of any age of people with rifampicin-resistant or multidrug-resistant tuberculosis, with a positive tuberculin skin test or immunologic impairment.
• How long: 6 months of daily levofloxacin, 30 months follow-up.
• Result: 6/1,023 (0.6%) versus 11 (1.1%); incidence rate ratio 0.55, 95% CI 0.19 to 1.62, not significant; any-grade adverse events 306 (31.9%) versus 125 (13.0%), risk difference 18.9 percentage points, 95% CI 14.2 to 23.6.
• Funding: National Health and Medical Research Council of Australia (independent of industry)

Confirmed tuberculosis occurred in 6 participants (0.6%) in the levofloxacin group and 11 (1.1%) in the placebo group (incidence rate ratio, 0.55; 95% confidence interval [CI], 0.19 to 1.62); this difference was not significant. There was little difference in grade 3 or 4 adverse events between the two groups (risk difference, 1.0 percentage point; 95% CI, -0.3 to 2.4). Adverse events of any grade were reported in 306 participants (31.9%) taking levofloxacin and 125 (13.0%) taking placebo (risk difference, 18.9 percentage points; 95% CI, 14.2 to 23.6).

Levofloxacin preventive treatment in children exposed to multidrug-resistant tuberculosis at home did not significantly reduce incident tuberculosis. (Source 26)

• Randomized trial, Moderate certainty.
• Size: 922 children from 497 households in South Africa.
• Who: children with household exposure to an adult with bacteriologically confirmed multidrug-resistant pulmonary tuberculosis; 91.0% were under 5 years old.
• How long: 24 weeks of treatment, primary endpoint at week 48.
• Result: 5/453 (1.1%) versus 12/469 (2.6%); hazard ratio 0.44, 95% CI 0.15 to 1.25; grade 2 tendonitis in one child on levofloxacin.
• Funding: Unitaid and others.

By week 48, tuberculosis had developed in 5 participants (1.1%) in the levofloxacin group and in 12 participants (2.6%) in the placebo group (hazard ratio, 0.44; 95% confidence interval [CI], 0.15 to 1.25). The results of sensitivity analyses were consistent with those of the primary analysis. Grade 3 or higher adverse events during the treatment period that were considered to be at least possibly related to the trial regimen occurred in 4 participants in the levofloxacin group and in 8 participants in the placebo group (hazard ratio, 0.52; 95% CI, 0.16 to 1.71). Grade 2 tendonitis occurred in 1 child in the levofloxacin group.

A multinational cohort of 13.6 million people treated for urinary tract infection found no increase in aortic aneurysm or dissection with fluoroquinolones compared with two other antibiotic classes. (Source 27)

• Cohort study, Moderate certainty.
• Size: 13,588,837 patients across 14 databases in 5 countries.
• Who: patients aged 35 or older starting systemic fluoroquinolones or comparable antibiotics for urinary tract infection in outpatient care, 2010-2019.
• How long: primary outcome within 60 days of exposure.
• Result: versus trimethoprim: absolute rate difference 0.21 per 1000 person-year, calibrated HR 0.91, 95% CI 0.73-1.10; versus cephalosporins: 0.11 per 1000 person-year, calibrated HR 1.01, 95% CI 0.82-1.25.
• Funding: government and university funding in Korea, Australia and the United States (independent of industry)

For the 60-day follow-up there was no difference in risk of AA/AD between FQ and TMP (absolute rate difference [ARD], 0.21 per 1000 person-year; calibrated HR, 0.91 [95% CI 0.73-1.10]). There was no significant difference in risk for FQ versus CPH (ARD, 0.11 per 1000 person-year; calibrated HR, 1.01 [95% CI 0.82-1.25]).

Where the evidence is mixed

In a network meta-analysis of oral antibiotics for mild-to-moderate community-acquired pneumonia, levofloxacin ranked near the top for clinical response and lower mortality, but no antibiotic was clearly better than another. (Source 3)

• Meta-analysis, Low certainty.
• Size: 24 studies with 9,361 patients.
• Who: adults with radiologically confirmed mild to moderate community-acquired pneumonia initially treated orally.
• How long: not stated in the abstract.
• Result: p-score 0.71 for clinical response and 0.85 for lower mortality for levofloxacin; 12 of 24 studies at high risk of bias; all confidence intervals broad and partially overlapping.
• Funding: not stated.

Limit of this finding: The p-scores in this quotation are rankings, not event rates. A p-score is the probability that one antibiotic is better than the others in the network, so a score of 0.71 does not mean 71 per cent of people got better. The authors say in the same passage that all the confidence intervals were broad and partially overlapping, which means the ranking order is not reliable and no antibiotic in this analysis was shown to be better than another.

Nemonoxacin, levofloxacin, and telithromycin were most likely to achieve clinical response (p-score 0.79, 0.71, and 0.69 respectively), while penicillin and amoxicillin were least likely to achieve clinical response. Levofloxacin, nemonoxacin, azithromycin, and amoxicillin-clavulanate were most likely to be associated with lower mortality (p-score 0.85, 0.75, 0.74, and 0.68 respectively). By antibiotic class, quinolones and macrolides were most effective for clinical response (0.71 and 0.70 respectively), with amoxicillin-clavulanate plus macrolides and beta-lactams being less effective (p-score 0.11 and 0.22). Quinolones were most likely to be associated with lower mortality (0.63). All confidence intervals were broad and partially overlapping.

Where the research disagrees

Whether fluoroquinolones increase the risk of aortic aneurysm and dissection

• Chen and colleagues, meta-analysis of 11 cohort studies, 2026, meta-analysis of cohort studies, 81,976,958 participants: The risk of AA/AD among FQs users was found to be elevated (HR = 1.20, 95% CI: 1.06-1.35). Similar results were found for AA (HR = 1.47, 95% CI: 1.24-1.73) and AD (HR = 1.12, 95% CI: 1.04-1.22). (Source 18)
• Janetzki and colleagues, multinational network cohort study, 2025, retrospective cohort across 14 databases in 5 countries with propensity matching and negative-control calibration, 13,588,837 patients: There was no increased risk of AA/AD associated with FQ compared to TMP or CPH in patients treated for UTI in the outpatient setting. (Source 27)
• The U.S. label for levofloxacin oral solution, SPL effective 2025-09-01, regulatory position citing epidemiologic studies: Epidemiologic studies report an increased rate of aortic aneurysm and dissection within two months following use of fluoroquinolones, particularly in elderly patients. (Source 22)

Whether fluoroquinolones raise the risk of nervous system harm after short courses for uncomplicated urinary infection

• Ellis and colleagues, propensity-matched cohort, 2021, propensity score-matched inception cohort, 976,568 exposed adults: The hazard ratio associated with fluoroquinolone exposure was 1.08 (95% confidence interval 1.05-1.11) for CNS dysfunction, and 1.09 (95% CI 1.07-1.11) for the most commonly occurring PNS dysfunction outcome. (Source 16)
• Mitrani-Gold and colleagues, cohort study of uncomplicated urinary tract infection, 2024, retrospective cohort with inverse probability of treatment weighting, 954,777 female outpatients: Patients receiving FQ had lower hazard of neurological (0.95 [0.93-0.97]; P < 0.0001), central nervous system (0.85 [0.80-0.89]; P < 0.0001), and peripheral nervous system (0.96 [0.93-0.98]; P = 0.0016) AESIs versus NTF. (Source 15)

How much

• Reference intake: There is no population reference intake for levofloxacin: it is a prescription antibacterial and the dose is set by the prescriber for the specific infection. As a position, the manufacturer's label (SPL effective 2025-09-01) states the usual dose of levofloxacin oral solution is 250 mg, 500 mg or 750 mg orally every 24 hours as indicated by the infection, and that lower doses are required below a creatinine clearance of 50 mL/min. (Source 25)
• Upper limit: The label's highest listed adult dose, as a position of the sponsor and FDA (SPL effective 2025-09-01), is 750 mg every 24 hours, used for nosocomial pneumonia, complicated skin infections, 5-day community-acquired pneumonia, 5-day complicated urinary tract infection or acute pyelonephritis, and 5-day acute bacterial sinusitis. Durations range from 3 days for uncomplicated urinary tract infection to 60 days for inhalational anthrax post-exposure. (Source 25)
• Studied: The TEAMM trial gave 500 mg of levofloxacin as two 250 mg tablets orally once daily for 12 weeks, with dose reduction by estimated glomerular filtration rate every 4 weeks. (Source 5)
• Studied: The VQUIN trial gave 6 months of daily weight-based levofloxacin to household contacts of people with rifampicin-resistant or multidrug-resistant tuberculosis. (Source 6)
• Studied: The TB-CHAMP trial gave levofloxacin or placebo once daily for 24 weeks to children with household exposure to multidrug-resistant tuberculosis. (Source 26)
• Studied: Pooled Phase 3 trials behind the label exposed 7,537 patients to 750 mg once daily, 250 mg once daily, or 500 mg once or twice daily, usually for 3 to 14 days. (Source 20)

A common belief, and what the research shows

The belief: An antibiotic is an antibiotic, so for a urine infection or a chest cold it does not much matter which one you are given.

What the research shows: For levofloxacin the regulator disagrees, and says so inside the boxed warning. The label reserves levofloxacin for people with no alternative in uncomplicated urinary tract infection, acute bacterial exacerbation of chronic bronchitis and acute bacterial sinusitis, the three mildest indications, because the class is associated with disabling and potentially irreversible reactions: "reserve levofloxacin for use in patients who have no alternative treatment options for the following indications:". The indication section adds a second reason: "for some patients uncomplicated urinary tract infection is self-limiting". Against that, 12 of the 24 trials in the best network meta-analysis of oral antibiotics for pneumonia were at high risk of bias, and it reported "no conclusive evidence of any antibiotic being clearly more effective than another" - so the difference between antibiotics here is mostly about harm, not about cure.

Questions and answers

What is it?

Levofloxacin is a prescription antibacterial drug of the fluoroquinolone class, the single active mirror-image form of an older drug called ofloxacin. It is given as tablets, a liquid or a drip. The U.S. label simply names the class and refers to its microbiology section for the detail. (Source 1)

What does it do in the body?

It kills bacteria. Fluoroquinolones work by blocking the bacterial enzymes that handle DNA, which stops the bacterium reproducing. The label is unusually brief here: it states the class membership and points to the microbiology section rather than describing the mechanism, so the class attribution is what this monograph records from the label. (Source 1)

Is it good or bad for you?

It depends entirely on the infection. For serious infections such as pneumonia, and for preventing infection in newly diagnosed myeloma where a placebo-controlled trial cut febrile episodes from 27% to 19%, the balance can favour treatment. For the mildest approved indications the regulator's own position is that it should be a last resort. Harm findings in this monograph include tendon disorders, nervous system effects, blood sugar swings, Clostridioides difficile diarrhoea and QT prolongation. (Source 2)

How do you get more of it?

Levofloxacin is not something a person obtains or increases: it is a prescription-only antibacterial and the amount is decided by a prescriber for a specific infection. The label records usual adult doses of 250 mg, 500 mg or 750 mg every 24 hours, varying by infection, and requires lower doses when kidney function is reduced. This monograph gives no dose for a reader to act on. (Source 25)

If it is harmful, what reduces it?

If a serious reaction appears, the label's instruction to the prescriber is to stop levofloxacin immediately and avoid fluoroquinolones in that person afterwards. Nothing in the literature we searched speeds its removal from the body; dose reduction in kidney impairment exists because the drug is cleared more slowly, not as a treatment for a reaction. (Source 12)

Why might someone be low in it or missing it?

The question does not apply in the usual sense: nobody is naturally low in levofloxacin. What does happen is that blood levels come out lower than intended when the dose is taken alongside antacids, iron, zinc-containing multivitamins or sucralfate, which bind it in the gut; the label says the result is systemic levels considerably lower than desired. Reduced kidney function has the opposite effect and requires a lower dose. (Source 7)

Which whole foods contain it or feed it?

No whole food contains levofloxacin; it is a manufactured drug. Food matters only in the other direction. A systematic review of quinolone dietary interactions found milk reduced absorption for half the quinolones studied, and that both ciprofloxacin and levofloxacin absorbed less well with orange juice, particularly calcium-fortified orange juice. (Source 8)

What happens if you do not have it?

Not taking levofloxacin is the normal state and carries no deficiency. What the evidence addresses is what happens if a bacterial infection goes untreated or is treated with something else. For the three mildest indications the label itself notes that uncomplicated urinary tract infection is self-limiting for some patients, and the pneumonia network meta-analysis found no antibiotic clearly superior to another. (Source 4)

How can you test for it?

There is no routine blood test for levofloxacin levels in ordinary care. The test that governs its use is a culture and susceptibility test on the infecting organism, and the label says this should be done before treatment and may be repeated during therapy because resistance can emerge; Pseudomonas aeruginosa in particular may become resistant fairly rapidly. Blood glucose monitoring is advised in people with diabetes taking it. (Source 4)

References

1. DailyMed (U.S. National Library of Medicine), Structured Product Label. LEVOFLOXACIN SOLUTION [LANNETT COMPANY, LLC], SPL effective 2025-09-01 - 12 CLINICAL PHARMACOLOGY, 12.1 Mechanism of Action. 2025. Read the source
2. DailyMed (U.S. National Library of Medicine), Structured Product Label. LEVOFLOXACIN SOLUTION [LANNETT COMPANY, LLC], SPL effective 2025-09-01 - BOXED WARNING SECTION (LOINC 34066-1). 2025. Read the source
3. J Gen Intern Med. Identifying the Best Initial Oral Antibiotics for Adults with Community-Acquired Pneumonia: A Network Meta-Analysis.. 2024. PMID 38360961, DOI 10.1007/s11606-024-08674-1. Read the source
4. DailyMed (U.S. National Library of Medicine), Structured Product Label. LEVOFLOXACIN SOLUTION [LANNETT COMPANY, LLC], SPL effective 2025-09-01 - Indications and Usage 1.12 Uncomplicated Urinary Tract Infections. 2025. Read the source
5. Lancet Oncol. Levofloxacin prophylaxis in patients with newly diagnosed myeloma (TEAMM): a multicentre, double-blind, placebo-controlled, randomised, phase 3 trial.. 2019. PMID 31668592, DOI 10.1016/S1470-2045(19)30506-6. Read the source
6. N Engl J Med. Levofloxacin for the Prevention of Multidrug-Resistant Tuberculosis in Vietnam.. 2024. PMID 39693541, DOI 10.1056/NEJMoa2314325. Read the source
7. DailyMed (U.S. National Library of Medicine), Structured Product Label. LEVOFLOXACIN SOLUTION [LANNETT COMPANY, LLC], SPL effective 2025-09-01 - Drug Interactions 7.1 Chelation Agents: Antacids, Sucralfate, Metal Cations, Multivitamins. 2025. Read the source
8. Clin Pharmacokinet. Together or Apart? Revealing the Impact of Dietary Interventions on Bioavailability of Quinolones: A Systematic Review with Meta-analyses.. 2024. PMID 38807006, DOI 10.1007/s40262-024-01377-0. Read the source
9. Clin Pharmacokinet. Together or Apart? Revealing the Impact of Dietary Interventions on Bioavailability of Quinolones: A Systematic Review with Meta-analyses.. 2024. PMID 38807006, DOI 10.1007/s40262-024-01377-0. Read the source
10. DailyMed (U.S. National Library of Medicine), Structured Product Label. LEVOFLOXACIN SOLUTION [LANNETT COMPANY, LLC], SPL effective 2025-09-01 - Warnings and Precautions 5.13 Blood Glucose Disturbances. 2025. Read the source
11. DailyMed (U.S. National Library of Medicine), Structured Product Label. LEVOFLOXACIN SOLUTION [LANNETT COMPANY, LLC], SPL effective 2025-09-01 - Warnings and Precautions 5.11 Prolongation of the QT Interval. 2025. Read the source
12. DailyMed (U.S. National Library of Medicine), Structured Product Label. LEVOFLOXACIN SOLUTION [LANNETT COMPANY, LLC], SPL effective 2025-09-01 - Warnings and Precautions 5.1 Disabling and Potentially Irreversible Serious Adverse Reactions. 2025. Read the source
13. DailyMed (U.S. National Library of Medicine), Structured Product Label. LEVOFLOXACIN SOLUTION [LANNETT COMPANY, LLC], SPL effective 2025-09-01 - Warnings and Precautions 5.3 Peripheral Neuropathy. 2025. Read the source
14. Front Pharmacol. Positive Association Between Fluoroquinolone Exposure and Tendon Disorders: A Nationwide Population-Based Cohort Study in Taiwan.. 2022. PMID 35387340, DOI 10.3389/fphar.2022.814333. Read the source
15. Antimicrob Agents Chemother. Risk of collagen-related disorders and neurological events among patients with uncomplicated urinary tract infection following short treatment with fluoroquinolones: a cohort study.. 2024. PMID 39470200, DOI 10.1128/aac.00690-24. Read the source
16. Pharmacoepidemiol Drug Saf. Comparative neurological safety of fluoroquinolones versus therapeutic alternatives.. 2021. PMID 33655544, DOI 10.1002/pds.5219. Read the source
17. Clin Infect Dis. Risk of severe dysglycemia among diabetic patients receiving levofloxacin, ciprofloxacin, or moxifloxacin in Taiwan.. 2013. PMID 23948133, DOI 10.1093/cid/cit439. Read the source
18. Vascular. Risk of aortic aneurysm/aortic dissection associated with fluoroquinolones use: A meta-analysis of cohort studies.. 2026. PMID 41678806, DOI 10.1177/17085381261425725. Read the source
19. J Antimicrob Chemother. Antibiotics and healthcare facility-associated Clostridioides difficile infection: systematic review and meta-analysis 2020 update.. 2021. PMID 33787887, DOI 10.1093/jac/dkab091. Read the source
20. DailyMed (U.S. National Library of Medicine), Structured Product Label. LEVOFLOXACIN SOLUTION [LANNETT COMPANY, LLC], SPL effective 2025-09-01 - Adverse Reactions 6.2 Clinical Trial Experience (incidence and discontinuation rates). 2025. Read the source
21. DailyMed (U.S. National Library of Medicine), Structured Product Label. LEVOFLOXACIN SOLUTION [LANNETT COMPANY, LLC], SPL effective 2025-09-01 - Warnings and Precautions 5.2 Tendinitis and Tendon Rupture. 2025. Read the source
22. DailyMed (U.S. National Library of Medicine), Structured Product Label. LEVOFLOXACIN SOLUTION [LANNETT COMPANY, LLC], SPL effective 2025-09-01 - Warnings and Precautions 5.9 Risk of Aortic Aneurysm and Dissection. 2025. Read the source
23. DailyMed (U.S. National Library of Medicine), Structured Product Label. LEVOFLOXACIN SOLUTION [LANNETT COMPANY, LLC], SPL effective 2025-09-01 - Warnings and Precautions 5.10 Clostridium difficile-Associated Diarrhea. 2025. Read the source
24. DailyMed (U.S. National Library of Medicine), Structured Product Label. LEVOFLOXACIN SOLUTION [LANNETT COMPANY, LLC], SPL effective 2025-09-01 - 4 CONTRAINDICATIONS. 2025. Read the source
25. DailyMed (U.S. National Library of Medicine), Structured Product Label. LEVOFLOXACIN SOLUTION [LANNETT COMPANY, LLC], SPL effective 2025-09-01 - Dosage and Administration 2.1 Dosage in Adult Patients with Normal Renal Function; with all nine of Table 1’s footnotes. 2025. Read the source
26. N Engl J Med. Levofloxacin Preventive Treatment in Children Exposed to MDR Tuberculosis.. 2024. PMID 39693542, DOI 10.1056/NEJMoa2314318. Read the source
27. eClinicalMedicine. Risk of aortic aneurysm or dissection following use of fluoroquinolones: a retrospective multinational network cohort study.. 2025. PMID 39975698, DOI 10.1016/j.eclinm.2025.103096. Read the source