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  • 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
      • tendonitis or tendon rupture
      • QT prolongation
      • contraindicated in pregnancy, nursing mothers, and < 18 years of age
        • secondary to possible cartilage damage
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