Ofloxacin (Ocuflox) vs. Levofloxacin (Levaquin)

• Ofloxacin and levofloxacin are fluoroquinolone antibiotics used to treat bacterial infections such as pneumonia, bronchitis, staph infections, STDs (gonorrhea, chlamydia), urinary tract infections (UTIs), and prostate infections caused by E. coli.
• Levofloxacin is also used for treating bacterial infections of the sinuses, skin, ears, airways, bones, and joints; infectious diarrhea caused by E. coli, Campylobacter jejuni, and Shigella bacteria; obstetric infections, including mastitis (infection of the breast); inhalational anthrax exposure; and for preventing and treating plague caused by Yersinia pestis.
• A brand name for ofloxacin is Ocuflox. The Floxin brand of ofloxacin has been discontinued.
• A brand name for levofloxacin is Levaquin.
• Side effects of ofloxacin and levofloxacin that are similar include nausea, vomiting, diarrhea, insomnia, headache, dizziness, itching, and allergic reactions (such as hives and anaphylaxis).
• Ofloxacin, levofloxacin, and other fluoroquinolones have been associated with tendinitis and tendon rupture, particularly the Achilles tendon.
• Side effects of ofloxacin that are different from levofloxacin include vaginitis, anxiety, euphoria, hallucinations, low or high blood sugar levels (especially in people with diabetes), and skin sensitivity to sunlight (photosensitivity).
• Side effects of levofloxacin that are different from ofloxacin include constipation, abdominal pain, rash, and abdominal gas.

Ofloxacin is a fluoroquinolone antibiotic used to treat bacterial infections such as pneumonia, bronchitis, staph infections, STDs (gonorrhea, chlamydia), urinary tract infections (UTIs), and prostate infections caused by E. coli. Other fluoroquinolone antibiotics include levofloxacin (Levaquin), ciprofloxacin (Cipro), gatifloxacin (Tequin), norfloxacin (Noroxin), moxifloxacin (Avelox), and trovafloxacin (Trovan). Ofloxacin stops the multiplication of bacteria by inhibiting the reproduction and repair of their genetic material (DNA).

Levofloxacin is a fluoroquinolone antibiotic used for treating bacterial infections of the sinuses, skin, lungs, ears, airways, bones, and joints; urinary infections, including those resistant to other antibiotics, as well as prostatitis (infection of the prostate); infectious diarrhea caused by E. coli, Campylobacter jejuni, and Shigella bacteria; obstetric infections, including mastitis (infection of the breast); inhalational anthrax exposure; and for preventing and treating plague caused by Yersinia pestis. Levofloxacin is an antibiotic that stops multiplication of bacteria by preventing the reproduction and repair of their genetic material, DNA. Other fluoroquinolones include ciprofloxacin (Cipro), norfloxacin (Noroxin), trovafloxacin (Trovan), and lomefloxacin (Maxaquin).

Ofloxacin

The most common side effects of ofloxacin include:

• nausea,
• vomiting,
• diarrhea,
• insomnia,
• headache,
• dizziness,
• itching, and
• vaginitis in women.

Allergic reactions have been described, such as hives and anaphylaxis (shock).

Other important side effects include symptoms of nervous system stimulation, such as:

• anxiety,
• euphoria, and
• hallucinations.

Ofloxacin may cause low or high blood sugar levels especially in people with diabetes who are taking insulin or oral hypoglycemic drugs.

Patients taking ofloxacin can develop skin sensitivity (photsensitivity) to direct sunlight and should avoid exposure to sunlight or use sun protection and sunscreens.

Ofloxacin as well as other antibiotics in the fluoroquinolone class of antibiotics, has been associated with tendinitis and even rupture of tendons, particularly the Achilles tendon. Some physicians recommend that patients discontinue vigorous exercise while they are taking fluoroquinolone antibiotics.

Ofloxacin should be used with caution in patients with central nervous system diseases such as seizures because rare seizures have been reported in patients receiving this medication.

Ofloxacin should be avoided in children and adolescents under 18 years of age, as safe use in these patients have not been established.

Many antibiotics, including ofloxacin, can alter the normal bacteria in the colon and encourage overgrowth of a bacterium responsible for the development of inflammation of the colon (Clostridium difficile, pseudomembranous colitis). Pseudomembranous colitis can cause fever, abdominal pain, diarrhea, and sometimes even shock.

Ofloxacin should not be used in patients with myasthenia gravis because it can increase muscle weakness.

Levofloxacin

Serious side effects and warnings include:

Levofloxacin as well as other antibiotics in the fluoroquinolone class of antibiotics have been associated with tendinitis and even rupture of tendons, particularly the Achilles tendon.

Fluoroquinolones have neuromuscular blocking activity and can worsen muscle weakness in individuals with myasthenia gravis.

The most frequently reported side effects are:

• Nausea or vomiting
• Diarrhea
• Headache
• Constipation

Less common side effects include:

• Difficulty sleeping
• Dizziness
• Abdominal pain
• Rash
• Abdominal gas
• Itching

Rare allergic reactions have been described are:

• Hives
• Anaphylaxis (shock)

Possible serious side effects of levofloxacin include:

• Peripheral neuropathy
• Central nervous system effects
• Hypoglycemia
• Hyperglycemia
• Clostridium difficile-associated diarrhea
• Abnormal heart beats
• Liver dysfunction
• Sun sensitivity

Other serious side effects and adverse events of levofloxacin include:

Levofloxacin should be used with caution in patients with central nervous system diseases such as seizures, because rare seizures have been reported in patients receiving Levaquin.

Levofloxacin should be avoided in children and adolescents less than 18 years of age, as safe use in these patients has not been established.

Many antibiotics, including levofloxacin, can alter the normal bacteria in the colon and encourage overgrowth of a bacterium responsible for the development of inflammation of the colon, (C. difficile or pseudomembranous colitis). Patients who develop signs of pseudomembranous colitis after starting Levaquin (diarrhea, fever, abdominal pain, and possibly shock) should contact their doctor immediately.

Patients taking Levofloxacin can develop sensitivity of the skin to direct sunlight (photosensitivity) and should avoid exposure to sunlight or use sunblock.

Fluoroquinolones worsen low blood glucose levels when combined with sulfonylureas (for example, glyburide [Micronase, Diabeta, Glynase, Prestab]).

Because of serious side effects associate with fluoroquinolones, they should not be used for treating uncomplicated urinary tract infections, acute bacterial exacerbation of chronic bronchitis or acute bacterial sinusitis unless there are no other alternatives.

Ofloxacin

• The usual dose for patients with normal renal function is 200 to 400 mg every 12 hours.
• Dosages require adjustment in patients with severely abnormal liver or kidney function.
• Oflaxacin is availabile as tablets: 200, 300, and 400mg.
• Ofloxacin should be stored in a closed container at 15 C - 30 C (59 F - 86 F).

Levofloxacin

• The usual dose is 250-750 mg given once daily for 3-14 days depending on the type of infection.
• Anthrax is treated with 500 mg daily for 60 days.
• It is important to take oral formulations at least 2 hours before or 2 hours after any antacid or mineral supplement containing iron, calcium, zinc, or magnesium since these bind Levaquin and prevent its absorption into the body.

Ofloxacin

Ofloxacin reduces the elimination of theophylline, elevating blood levels of theophylline. (Theophylline is used to open airways in the treatment of asthma.) If concurrent use of ofloxacin and theophylline cannot be avoided, frequent blood tests to monitor theophylline blood levels should be performed. Ofloxacin can enhance the action of the anticoagulant (blood thinner) warfarin (Coumadin), and increase the risk of bleeding. Both high and low blood sugar levels have been reported, especially in patients with diabetes who were also receiving insulin or other medications used to lower the blood sugar. Careful monitoring of blood sugar levels is recommended. Sucralfate (Carafate), iron, multivitamins containing zinc, didanosine (Videx), as well as antacids containing calcium, magnesium, or aluminum should not be taken within two hours before or after taking ofloxacin.

Levofloxacin

Iron, calcium, zinc, or magnesium can attach to levofloxacin and other fluoroquinolones and prevent their absorption from the intestine into the blood. Therefore, products (for example, antacids) that contain iron, calcium, zinc, or magnesium should be taken at least 2 hours before or 2 hours after levofloxacin. Other drugs that contain these minerals and can similarly interact with levofloxacin include sucralfate (Carafate) and didanosine (Videx, Videx EC).

Taking nonsteroidal anti-inflammatory drugs (NSAIDs) with levofloxacin may increase the risk of central nervous stimulation, resulting in over-excitation. There have been reports of changes in blood sugar (increases and decreases) in patients treated with fluoroquinolones and antidiabetic agents.

Fluoroquinolones may increase the effect of warfarin (Coumadin, Jantoven).

Ofloxacin

• Ofloxacin should be avoided during pregnancy because it is secreted in breast milk and can cause adverse events in the infant.
• Ofloxacin should be avoided in nursing mothers, as safe use has not been established.

Levofloxacin

• Levaquin is not recommended for use in pregnant women since Levaquin causes joint and bone deformities in juvenile animals of several species.
• Levaquin is excreted in breast milk. Mothers should decide whether to stop breastfeeding or discontinue Levaquin.