Levofloxacin

Fluoroquinolones, including levofloxacin are associated with disabling and potentially long-lasting or irreversible side effects. See Fluoroquinolone antibiotics - severe adverse effects

When using fluoroquinolones:

• DO NOT prescribe for:
  • non-severe or self-limiting infections.
  • mild to moderate infections (unless other antibiotics that are commonly recommended for these infections are considered inappropriate).
• DO read the Antimicrobial Guideline section: Fluoroquinolone antibiotics - severe adverse effects
• DO ensure penicillin allergies are properly clarified and consider de-labelling in appropriate patients to avoid the use of fluoroquinolones. See guidelines: Penicillin allergy assessment and overview and Penicillin allergy challenge and delabelling
• DO ensure all patients are given the MHRA fluoroquinolone patient leaflet (this is usually given to patients with their discharge and outpatient medications).

Note: This does not include Drug Resistant tuberculosis. The TB team will advise about treatment regimens and dosing. 

No dose adjustment required. Use the top end of usual dosing range after considering renal function.

Renal impairment

For treatment doses only. This does not apply to H.pylori eradication regimes or TB treatment. Please speak to pharmacist.

*dose ranges use creatinine clearance, rather than eGFR.

Hepatic impairment:

No dose adjustment required.

Cases of hepatic necrosis up to life threatening hepatic failure have been reported, primarily in patients with severe underlying diseases, e.g. sepsis. In the event of any signs and symptoms of hepatic disease (such as anorexia, jaundice, dark urine, pruritus, or tender abdomen), treatment should be discontinued.

1. Ipca Laboratories UK Ltd. Levofloxacin 500mg tablets summary of product characteristics. Electronic Medicines Compendium. Last revision of the text July 2025.  Accessed via www.medicines.org.uk Accessed 26/3/26.
2. Bowmed Ibisqus Limited. Levofloxacin 500mg/100ml solution for infusion vials (5mg/ml) summary of product characteristics. Electronic Medicines Compendium. Last revision of the text 1/11/24  Accessed via www.medicines.org.uk Accessed 26/3/26.
3. British National Formulary. Levofloxacin. BNF online accessed via www.medicinescomplete.com  Accessed 26/3/26.
4. The Renal Drug Database. Levofloxacin. Last updated 25/3/25. Accessed via https://renaldrugdatabase.com Accessed 31/1/26.
5. All-Wales Antimicrobial Pharmacists’ Group (2022) Antimicrobial dosing in extremes of body weight in adults. Accessed 26/3/26.
6. Sanford guide [online]. Levofloxacin. Last updated 23/3/26. Accessed via https://webedition.sanfordguide.com Accessed 26/3/26.
7. MHRA. Drug Safety update (January 2024) Fluoroquinolone antibiotics: must now only be prescribed when other commonly recommended antibiotics are inappropriate. Accessed HERE
8. MHRA. Drug Safety update (September 2023) Fluoroquinolone antibiotics: suicidal thoughts and behaviour. Accessed HERE
9. MHRA. Drug Safety update (August 2023) Fluoroquinolone antibiotics: reminder of the risk of disabling and potentially long-lasting or irreversible side effects. Accessed HERE
10. MHRA. Drug Safety update (December 2020) Systemic and inhaled fluoroquinolones: small risk of heart valve regurgitation; consider other therapeutic options first in patients at risk. Accessed HERE 
11. MHRA. Drug Safety update (March 2019) Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects. Accessed HERE
12. MHRA. Drug Safety update (November 2018) Systemic and inhaled fluoroquinolones: small increased risk of aortic aneurysm and dissection; advice for prescribing in high-risk patients. Accessed HERE