NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update Acute

Levofloxacin Monotherapy in Severe Community Acquired Pneumonia (Penicillin Allergic)

Levofloxacin is a broad spectrum fluoroquinolone antibiotic. It has recently been introduced to NHSGGC Empirical Antibiotic Prescribing Guidelines for the treatment of severe community acquired pneumonia (CAP) in adult patients with a true penicillin/beta-lactam allergy or if Legionella is strongly suspected.  Levofloxacin provides good atypical organism cover and therefore co-prescription of clarithromycin is not necessary.  The combination confers additional risks as both antibiotics have the potential to cause QTc prolongation; levofloxacin monotherapy is therefore recommended.

Misinterpretation of the NHSGGC Infection Management Guideline: Empirical Antibiotic Therapy poster has led to a few recent cases where levofloxacin and clarithromycin have been co-prescribed for severe CAP.  In light of this, prescribers are reminded that the recommended empirical treatment for severe CAP (penicillin allergic) is levofloxacin monotherapy.