Food and Drink Safety
     
 
Levofloxacin: A Drug for All Reasons
 
     
 

Travel medicine specialists are often asked whether there is one antibiotic which will cover all of a traveler¹s needs, especially when reliable medical care is not available. The drug of choice in this situation is levofloxacin (Levaquin®), a broad-spectrum fluoroquinolone antibiotic which provides excellent coverage for skin, respiratory, bowel and bladder/gyn infections.

For most infections, the dose is one 500-mg tablet daily for 3 days (uncomplicated bowel and bladder infections) to 7- to 14 days (skin and respiratory tract infections; acute PID; uncomplicated gonorrhea).

Levofloxacin is relatively contraindicated during pregnancy (Pregnancy Category C) and in children under 18 years of age. However, in the case of severe illness (e.g., dysentery with high fever and toxicity), most infectious disease consultants accept the use of fluoroquinolones in pregnant women and children.

 
   
     
  Azithromycin: The Best Alternative?  
     
  The best alternative to levofloxacin in children and adults is azithromycin (Zithromax®), an antibiotic related to erythromycin, that is safe for children and pregnant women. The spectrum of action for azithromycin is not as broad as levofloxacin, as noted by its lower efficacy for urinary tract infections. However, it is very effective for skin, respiratory, and bowel infections. For most infections, the adult dose is 500 mg the first day, followed by 250 mg daily for the next 4 days. The pediatric dose is 10 mg/kg on the first day, followed by 5 mg/kg daily for the next 4 days.  
   
     
 
Travelers' Diarrhea
 
     
  All travelers to developing countries should carry an antibiotic for the self-treatment of travelers' diarrhea. Ciprofloxacin (Cipro®) and norfloxacin (Noroxin®) are often prescribed for travelers' diarrhea, but levofloxacin provides a better spectrum of activity in the event of other illness. Azithromycin is the best all-purpose choice for pregnant women and children.  
     
 
Typhoid Fever
  
     
  Levofloxacin and azithromycin are also excellent drugs for the treatment of typhoid fever and have comparable cure rates. Dosage: Levofloxacin 500 mg daily (8 mg/kg/day) for 5 days. Azithromycin 1 gm daily (20 mg/kg/day) for 5 days.  
   
     

YemenOmanSaudi ArabiaUnited Arab EmiratesIraqQatarBahrainKuwaitIranCyprusLebanonJordanIsraelSyriaDjibouti
     
  Jay Keystone, MD  
     
 

June 2001
Good News for Advocates of Immunization

Previous Article(s):

March 2001
Tuberculosis and the International Traveler

January 2001
Levofloxacin:
A Drug for All Reasons

November 1999
Malarone: A New Option
for Malaria Prevention
and Treatment