Augmentin vs Zithromax vs Levaquin

October 11, 2015 at 6:14 PM

Augmentin (amoxicillin and clavulanate) vs Zithromax (azithromycin) vs Levaquin (Levofloxacin) (also known as Tavanic in Europe): comparison of medical uses, side effects, methods of administration, core components and precautions concerning these three antibiotics.

Do you have to give a music performance at your university function but suddenly you have a severe case of sore throat?

Bacterial infections can get out of hand pretty quickly and cause you pain and worry for days on end. But the correct antibiotic can prove to be an antidote to all your problems. Antibiotics are medicines that eliminate bacteria and stop them from reproducing. They also equip our immune system to fight disease in a more effective manner. However, antibiotics are ineffective when it comes to treating viral infections. Taking antibiotics unnecessarily may cause harm instead of good.

Antibiotics must be taken only when required and in proper dosage. Using antibiotics frequently can lead to antibiotic resistance which means that bacteria in your body become stronger and are able to resist effects of an antibiotic. Therefore, the next time you fall ill you have to take a stronger dose.


Antibiotics are mostly classified based on their mode of action, chemical composition or spectrum of activity. Main classes of antibiotics are as follows:

  • Penicillins
  • Cephalosporins
  • Macrolides
  • Fluoroquinolones
  • Tetracyclines
  • Aminoglycosides

Explained and compared below are some widely used antibiotics: Augmentin, Zithromax and Levaquin


Augmentin is the trade name of a combination antibiotic medicine containing amoxicillin and clavulanate. It belongs to penicillin class of antibiotics.


Penicillins are a group of antibiotics that originate from fungi called penicillium fungi. They hold a lot of fame in medicine because they were among the first antibiotics used to treat major infections and diseases. They are still used widely in modern age. They are all beta lactam antibiotics with a beta lactam nucleus. There are a variety of penicillins such as:

  • Amoxicillin
  • Ampicillin
  • Flucloxacillin

They are mainly bactericidal and show very low toxic effect on animal tissue.

Bacteria maintain their structural integrity by constantly rebuilding their cell walls. Penicillins act by destroying these protective cell walls.

Augmentin contains amoxicillin, a penicillin and is explained in greater detail below:


Each Augmentin 625 mg tablet contains amoxicillin trihydrate equivalent to 500 mg amoxicillin and potassium clavulanate equivalent to 125 mg of clavulanic acid.

Core components

Description of the two core components of Augmentin, amoxicillin and clavulanate is as follows:


This penicillin antibiotic is useful in treatment of many bacterial infections such as tonsillitis, pneumonia and infections of the ear, nose or throat. It works against many gram positive and gram negative bacteria. It is a β-lactam antibiotic. It contains a lactam ring in its molecular structure. It is considered first line of treatment for middle ear infections.

Amoxicillin first became available in market in 1972. It is mentioned on World Health Organization’s List Of Essential Medicines as one of the most important medications required in a basic health system.

Mode of action

Amoxicillin exerts its antibiotic effect by inhibiting bacterial cell wall synthesis. Lack of bacterial cell wall results in death due to lysis (cell disintegration due to rupture of cell wall or membrane) of bacteria.  It inhibits cross linkages between peptidoglycan polymer chains that are building blocks of cell walls of both gram positive and gram negative bacteria. Therefore amoxicillin is only effective against actively growing and cell wall synthesizing bacteria.

Medical uses

Amoxicillin is useful in treatment of these conditions:

  • Acute otitis media. It is a group of inflammatory diseases that affect middle ear. Middle ear becomes filled with fluid during infection. Eardrum bulges painfully often with drainage of purulent material. It is especially common among children below age of six because they have shorter Eustachian tube than adults.
  • Streptococcal pharyngitis. Pharyngitis is inflammation of pharynx, leading to sore painful throat and hoarse voice. Symptoms of streptococcal phryngitis are sore throat, high temperature, pus on tonsils and enlarged lymph nodes.
  • Pneumonia
  • Skin infections
  • Urinary tract infections
  • For prevention and treatment of anthrax. Anthrax is a serious infectious malady caused by gram positive bacteria Bacillus anthracis. These bacteria are found naturally in soil and mostly affect farm and wild animals over the world. Humans can get infected with this bacteria if they come in contact with diseased cattle and animals. Most forms of this disease are fatal and therefore require immediate medical attention. Early antibiotic treatment of anthrax is crucial. Delay reduces chances of survival. Manifestations of its symptoms are:
    • Pulmonary: Initially respiratory infection presents with cold or flu like symptoms followed by pneumonia and severe respiratory collapse that can potentially lead to death.
    • Gastrointestinal: Gastrointestinal problems are caused in people by consumption of anthrax affected meat. These present in form of severe GI disturbance, vomiting of blood, diarrhea, lesions of intestine and mouth.
    • Cutaneous: Hide’s porter disease or cutaneous anthrax presents its symptoms in the form of boil like lesions. They gradually form skin ulcers with a black center.
  • To treat Lyme disease spread by ticks. The causative bacteria is Borrelia burgdorferi. Symptoms include stiff neck, fever, chills, headache, lethargy, muscle aches and joint pain.
  • To prevent inflammation of tissues of heart or cardiac endocarditis in high risk people having dental work done. (1)

Adverse effects

Undesirable effects produced in patient by use of amoxicillin include:

  • Nausea, vomiting
  • Rashes
  • Antibiotic associated colitis
  • Mental adverse changes such as lightheadedness, insomnia, confusion, anxiety
  • Allergic reaction to amoxicillin can yield serious consequences in patient. Patient may even expire due to anaphylaxis. The early symptoms of an allergic reaction to amoxicillin are skin rash, severe itching, changes in mental state and fever, nausea and vomiting.
  • Over dosage of amoxicillin in young children has been known to cause lethargy, fatigue, vomiting and renal dysfunction. (2)


Clavulanate is a salt of clavulanic acid that is a β-lactamase inhibitor. In a lone state it is not effective as an antibiotic but when conjoined with penicillin antibiotics it can overcome antibiotic resistance in bacteria that secrete Beta-lactamase, which otherwise renders penicillins ineffective.

Mode of action

Penicillase is especially a potent beta-lactamase enzyme that destroys antibiotic activity of penicillins. These enzymes are secreted by bacteria when antibiotics are present in environment. Clavulanic acid binds to serine residue at active site of the enzyme. This restructures its configuration transforming it into a much more reactive species that is attacked by another amino acid at active site permanently inactivating the enzyme.(3)

Adverse effects

The use of combination medication including clavulanate increases risk of cholestatic jaundice and acute hepatitis.

Medical uses of Augmentin

As mentioned before, Augmentin or co-amoxiclav is a combination medicine. The combination of amoxicillin and potassium clavulanate results in an antibiotic medication with an increased range of action and higher efficacy against beta-lactamase secreting bacteria. It is used to treat these medical conditions (4):

  • Respiratory tract infections
  • Urinary tract infections
  • Skin infections
  • Anthrax
  • Cat scratches
  • Dental infections
  • Infected animal bites
  • Bronchitis. It is infection of mucous membranes of bronchial tubes. As the inflamed tubes swell and grow thicker; it shuts off airways leading to coughing spells that may be accompanied with phlegm and labored breathing.
  • Tonsillitis
  • Sinusitis
  • Ear infections 

Adverse effects

Generally, adverse effects produced by augmentin are mild and transient and do not bring about possibly fatal consequences.


Adverse effects brought about by Augmentin on GIT are (5):

  • Diarrhea
  • Nausea
  • Vomiting
  • Abdominal pain
  • Vomiting
  • Indigestion
  • Gastritis
  • Stomatitis (inflammation of mucous membrane of mouth)
  • Blackening of tongue
  • Candidiasis (fungal infection) affecting skin, genital area, throat and mouth. Its symptoms are white spots inside mouth and tongue, redness in mouth area, sore throat and difficulty in swallowing. Augmentin increases risk of candidiasis by abolishing good bacteria that keep candidiasis causing yeast at bay.
  • Colitis

The incidence of diarrhea has been found to increase with increasing doses.


Hepatic side effects include (6):
  • Moderate elevation in levels of serum transaminases. Elevated transaminases are an indicator of liver damage.
  • Hepatic dysfunction brought about by increased risk of cholestatic jaundice and hepatitis due to use of augmentin co-amoxiclav.
  • Rare cases of hepatic necrosis (liver cell injury) and hepatocellular damage have been reported.
  • Acute cytolytic hepatitis is caused due to amoxicillin present in augmentin. Symptoms of this disease are abdominal pain, jaundice, vomiting neurological signs of hepatic encephalopathy.
  • Hepatotoxicity due to hypersensitivity to this antibiotic.


Renal side effects are rare but not unheard of. Adverse effects on kidneys due to use of augmentin are (7):

  • Crystalluria. It refers to crystal formation in urine. It is an indication of renal damage.
  • Hematuria. Blood maybe found present upon examination of urine due to use of augmentin.
  • Acute renal failure
  • Acute interstitial nephritis. This condition has been observed in association with drug therapy with a number of drugs especially patients receiving amoxicillin therapy. There is an abrupt and sudden deterioration in renal function characterized by inflammation and edema of renal interstitium. The symptoms are rash, fever, elevated body temperature and eosinophilia. If untreated, it may cause reversible form of acute renal failure.


Hematologic side effects of augmentin include:
  • Hemolytic anemia (rare)
  • Henoch –Schonlein purpura syndrome has been linked with this medication. It is a disorder that causes inflammation and bleeding in small blood vessels of skin, joints, intestines and kidneys. Its most striking symptom is a purple rash and purplish blotches mostly on lower legs and buttocks. It is mostly observed in children between age of 2-6 years. It occurs mostly in autumn and winter.
  • Bone marrow arrest leading to neutropenia
  • Thrombocytopenia or deficiency of platelets in blood. This leads to bleeding into tissues, bruising and slow blood clotting after injury.
  • Anemia


Immunologic side effects include mucocutaneous candidiasis and vulvovaginal infection caused by fungi.


Patients allergic to amoxicillin experience adverse dermatologic reactions after using augmentin. These include eruption of rashes on skin, Stevens Johnson syndrome and exfoliative dermatitis.

Nervous system

Side effects on nervous system are:

  • Agitation
  • Anxiety
  • Behavioral changes
  • Convulsions
  • Dizziness


Hypersensitivity to amoxicillin clavulanate are more frequent in patients with history of allergy, hay fever, uriticaria, etc. (8)


Symptoms of augmentin overdosage are:

  • Abdominal or stomach pain
  • Cloudy urine
  • Diarrhea
  • Sleepiness and lethargy
  • Decreased amount of urine


Taking up any medication is a risky business because of possible adverse effects. Augmentin should also be used after consulting with your doctor and briefing him about medical history. Following precautions should be borne in mind before you start to use augmentin:

  • Do not use Augmentin if you are allergic to amoxicillin or clavulanate.
  • If you are allergic to penicillin antibiotic.
  • If you have history of liver or renal disease inform your physician about it.
  • If you are pregnant use after consulting with your doctor.
  • If you are using birth control pills avoid Augmentin because it renders them less effective. Use some other form of birth control instead.
  • Augmentin is present in breast milk. If you are a nursing mother consult your doctor about using this medication as it may harm health of the baby.
  • Augmentin may cause dizziness and confusion. Avoid driving while using this medicine.
  • It is ineffective against viral infections. Only use it for treatment of bacterial infection otherwise unnecessary use will be harmful for you.
  • Do not receive any live vaccine such as oral typhoid vaccine while taking Augmentin without prior consultation with your physician.
  • Augmentin can give false positive results for glucose presence in urine. Inform your doctor that you are taking Augmentin before a test for diabetes or blood sugar.
  • Augementin should be given to children with extreme care and caution especially underweight ones. Children are more vulnerable to side effects of Augmentin
  • Make sure to use full course of treatment of this combination antibiotic. If not, your infection may remain untreated. What’s more, bacteria in your system may become resistant to it and it will be harder to fight them off in future.
  • If you are phenylketonuric and unable to process phenylalanine avoid using oral suspension and chewable tablets of Augmentin because these forms contain phenylalanine.
  • If you have mononucleosis. It is a viral infectious disease. The disease is characterized by fever, sore throat and lethargy. Taking Augmentin during mono increases skin rashes.
  • Some drugs may interact with Augmentin. Provide your doctor with full details of your medication history especially if you are using any of the following:
    • Anticoagulants such as warfarin because risk of bleeding might be elevated.
    • Probenecid makes patient more vulnerable to harmful side effects of Augmentin.
    • Macrolide antibiotics such as erythromycin, sulfonamides or tetracycline antibiotics such as doxycycline because they can decrease effectiveness of Augmentin.
    • Risks of side effects of methotrexate are raised after using Augmentin.
  • Long term or prolonged use of Augmentin may cause a second infection.
  • It is advisable to carry out periodic assessment of organs such as urine tests, renal function tests and liver function tests while using Augmentin for prolonged time to determine any adverse effects of therapy.

Method of administration

Augmentin is for oral administration. It is available in form of tablets and suspension.

How to use Augmentin

Use Augmentin as prescribed by your doctor and do not take dosage more than necessary. Check label on bottle for exact instructions.

  • Take tablets with water.
  • The Augmentin tablet should be ingested by swallowing whole.
  • While giving children oral suspension, measure the dose carefully.
  • Take Augmentin according to timing schedule prescribed by your physician.
  • Take Augmentin before meals to avoid adverse effects on stomach and digestion. Abdominal pain is frequently reported when Augmentin is ingested with an empty stomach.
  • To fully treat your infection, it is highly advised to take Augmentin for complete course of treatment. Do not give up its use even if you feel better after a few days.
  • Do not miss out on doses.
  • If you miss a dose, try to take it as soon as you can. If it is nearly time for your next dose, skip the missed dose and carry on with your regular dose schedule. Do not take two doses together.


Store Augmentin bottle at room temperature away from heat, light and moisture. Store Augementin suspension in your fridge. If you take out oral suspension after a long time, be sure to ascertain its expiration date.


Zithromax belongs to macrolide class of antibiotics and subgroup azalide. Azalides are macrolide antibiotics having a nitrogen in their macrolide ring.


Macrolides are a class of antibiotics having a large macrocyclic lactone ring consisting of 14 to 20 atoms. Macrolides suppress disease causing ability of bacteria by binding to 50S subunit of bacterial ribosome. They inhibit bacterial ribosomal translocation. They block bacterial protein synthesis.

They are mostly effective against gram positive bacteria.

These bactericidal agents are widely used to treat infections. Erythromycin , azithromycin, clarithromycin and roxithromycin are macrolide antibiotics. This group of antibiotics is secreted by Streptomyces which are spore forming bacteria.

Zithromax is discussed in greater detail below:


Active ingredient in zithromax is azithromycin. Besides this, zithromax capsules contain: Lactose, magnesium stearate, maize starch, and sodium lauryl sulphate.

Core component

The core component of zithromax is azithromycin.

Medical uses

Zithromax is used to treat a wide variety of bacterial infections including:

  • Respiratory tract infections caused by streptococcal bacteria.
  • Infectious sexually transmitted diseases.
  • Chlamydia is a commonly sexually transmitted infection in humans caused by bacterium Chlamydia trachomatis. Chlamydia is an important infectious cause of human genitals and ocular disease. Causative bacteria is naturally found in human body. Besides inflammation of genital organs, chlamydia causes reactive arthritis.
  • Gonorrhea
  • Infections of middle ear caused by H. Influenzae bacteria, S. Pneumoniae bacteria
  • Pneumonia and severe sinusitis
  • Chronic bronchitis
  • Skin infections caused by bacteria
  • Intestinal infection caused by Campylobacter bacteria
  • Whooping cough or pertussis. Its initial symptoms are akin to those of common cold such as runny nose, fever and mild cough. It is then followed by weeks of coughing fits. Coughing fits lead to vomiting and fatigue. It is caused by bacteria Bordetella pertussis. Treatment with antibiotic abolishes threat of infection after five days.
  • It used in treatment to prevent bacterial infection of a heart valve.
  • Peptic ulcer and duodenal ulcer linked to Helicobacter pylori.
  • Lyme disease

Mechanism of action

Azithromycin present in zithromax inhibits bacterial protein synthesis, it accumulates effectively in cells and is transported to site of infection. It binds to 50S subunit of bacterial ribosome. It inhibits and impedes translation of mRNA.

Side effects

Like every other drug, zithromax also exerts harmful adverse effects on patient’s body. These are as follows:


Gastrointestinal side effects include (9):

  • Nausea
  • Vomiting
  • Diarrhea
  • Dyspepsia
  • Flatulence
  • Mucositis. It is painful inflammation of mucous membranes lining gastrointestinal tract.
  • Flatulence and bloating
  • Constipation in some cases
  • Mild to life threatening pseudomembranous colitis


Hepatic side effects of zithromax include:
  • Raised levels of bilirubin
  • Rarely hepatitis and cholestatic jaundice
  • Hepatic necrosis


Adverse effects on cardiovascular system reported in patients using zithromycin are:

  • Arrythmias including ventricular tachycardia
  • Torsades de pointes. It is a type of ventricular tachycardia that could possibly result in sudden cardiac failure.
  • Palpitations
  • Hypotension
  • Pain in chest


Renal side effects caused by use of zithromax are:

  • Elevated levels of serum creatinine
  • Raised concentration of blood urea nitrogen
  • Interstitial nephritis
  • Acute renal failure

Nervous system

Nervous system adverse effects include:

  • Headache
  • Somnolence, drowsiness and lethargy
  • Vertigo and dizziness
  • Confusion
  • Agitation
  • Fainting
  • Convulsions

Hearing disturbances

Hearing disturbances such as hearing loss, deafness and tinnitus have been observed in patients using zithromycin but occurrence is rare.


Aggressive behavior development in patients who use this medication for prolonged period of time has been observed.


Hematologic side effects include:

  • Decreased level of lymphocytes
  • Leukopenia. It is decreased amount of white blood cells or leukocytes making patient more vulnerable to infections.
  • Thrombocytopenia


Dermatological side effects caused by use of zithromax are:

  • Photosensitivity
  • Stevens-Johnson syndrome
  • Rash
  • Uritacaria. Hives are formed over skin in form of pale red, raised itchy bumps.


Due to its adverse effects on liver and heart, this antibiotic must be used with extreme caution and only when necessary. Do not start zithromycin therapy without consulting your doctor.

To ensure this medication is safe for you, inform your doctor if you have:

  • Liver disease
  • History of renal disease
  • Myasthenia gravis
  • Disorder of heart rhythm
  • History of long QT interval syndrome

Myasthenia gravis

Myathenia gravis literally means “grave muscular weakness.” Its most common form is an autoimmune disorder that weakens voluntary muscles. It is characterized by fluctuating weakness of muscles. It is not a genetically inherited disorder, age related or contagious. Initial symptoms include:

  • Drooping eyelids
  • Blurred or double vision
  • Slurred speech
  • Difficulty in chewing and swallowing
  • Weakness in arms and legs
  • Muscle fatigue
  • Labored breathing

Muscle weakness in myasthenia gravis is caused by circulating antibodies that inhibit excitatory effect of neurotransmitter acetylcholine at postsynaptic neuromuscular junction. It is further associated with other autoimmune diseases such as lupus and thyroid diseases.

Antibiotics like zithromax exacerbate muscle weakening effect of this autoimmune disease. 


Serious allergic reactions have been reported in patients sensitive to azithromycin. These reactions are:

  • Angioedema
  • Anaphylaxis
  • Stevens Johnson syndrome
  • Toxic epidermal necrolysis

Hypersensitivity reactions have led to deaths in some cases. If an allergic reaction occurs, discontinue use of medicine immediately and institute proper remedial therapy. Ascertain that you are not allergic to azithromycin before taking up the therapy.


Do not use zithromax if you have medical history of liver disease. In case of prolonged therapy, get your liver function tests done once in a while to make sure that your liver is safe. If signs of liver disease begin to appear, discontinue use of this medication at once.

QT Prolongation

Prolonged cardiac repolarization and increased risk of cardiac failure, especially in elderly patients has been observed with use of zithromycin. Patients suffering from ongoing proarrhythmic conditions such as uncorrected hypokalemia or hypomagnesemia, clinically significant bradycardia, and in patients receiving Class IA (quinidine, procainamide) or Class III (dofetilide, amiodarone, sotalol) antiarrhythmic agents should avoid use of this drug.

If you have history of cardiac disease or arryhtmias avoid using this medicine. Also avoid using it if you are taking drugs known to prolong QT interval. (10)


No considerable harmful effects or fetotoxicity has been observed in pregnant women who used zithromax.


Zithromax is secreted into breast milk therefore nursing mothers should use it with care.


Zithromax is not suitable for children below 6 years of age.

Routes of administration

Zithromax is present in powdered form for injection, oral suspension and in capsule for oral ingestion.

How to take zihtromax

While using this medication, follow instructions and prescription of your doctor strictly. Follow directions on label of medicine. Do not take this medication for longer than needed as that can build up antibiotic resistance in your system. Also, do not end it before completing the course because your infection will remain untreated. The dose and duration of treatment with zithromycin varies according to type of infection.

You may take most forms of zithromycin before or after meals, it is up to you. If you experience gastrointestinal disturbances, switch your dose after meals.

When using oral suspension, do not save up left over medicine in packet and discard it. Shake bottle well before pouring the medicine and use a dose measuring device. If you do not have one at home, purchase it from pharmacy or medical store.

Store at room temperature away from moisture and heat, especially oral capsules.  Do not use this antibiotic for viral infections such as flu.

Missed dose

Take the missed dose as soon as you can. Do not take two doses together as that can prove to be very harmful and put you at risk of over dosage.


Levaquin is the trade name for levofloxacin, a broad spectrum antibiotic used to treat many infections. Levaquin belongs to a class of antibiotics known as fluoroquinolones.


Fluoroquinolones are a group of antibiotic drugs which are systemic antibacterial agents that are widely used to treat respiratory and urinary tract infections. They are active against a large range of gram positive and gram negative bacteria.

Fluoroquinones exert their antibacterial action by stopping bacterial DNA from unwinding and duplicating. Fluoroquinolones popular in medicine are:

  • Ciprofloxacin
  • Gemifloxacin
  • Levofloxacin
  • Moxifloxacin
  • Norfloxacin
  • Ofloxacin

These antibiotics are well absorbed and well tolerated with low rate of adverse effects. Their most pronounced adverse effect is on musculoskeletal system. Fluoroquinolones causing severe hepatotoxicity were pulled from the market.

The fluoroquinolone levofloxacin (levaquin) is discussed in detail below:

Core component

Levofloxacin is a core component of levaquin.

Mechanism of action

Levaquin is a broad spectrum antibiotic efficient in treating infections caused by both gram positive and gram negative bacteria. Like other members of class fluoroquinolone, it works by inhibiting type II topoisomerase enzymes, DNA gyrase and topoisomerase IV.

DNA gyrase

DNA gyrase or DNA topoisomerase II relieves strain while double stranded DNA is being unwound by helicase enzyme. This leads to negative supercoiling of bacteria. The capability of this enzyme to relax supercoils allows superhelical tension before polymerase to be released so replication can continue. When its activity is blocked, bacterial replication cannot take place.

Topoisomerase IV

This enzyme performs two functions during replication:

It is responsible for unlinking DNA strands. This unlinking is essential so that the daughter cells can segregate and cell division can be complete.

Along with DNA gyrase it relaxes positive super coils.

By blocking action of these enzymes, levofloxacin (levaquin) kills bacteria and acts as a bactericidal agent.

Medical uses

Levaquin is used to treat these medical conditions:

  • Respiratory tract infections
  • Cellulitis is a widespread infection of skin and soft tissues underneath. Infection leads to swelling, pain, redness and warmth.
  • Urinary tract infections
  • Prostatitis. It is swelling and inflammation of prostate gland.
  • Anthrax
  • Endocarditis
  • Meningitis
  • Plague
  • Tuberculosis

This bactericidal agent actively eliminates important respiratory pathogen  Streptococcus pneumoniae.

Side effects


Adverse effects of levaquin on GIT are (11):

  • Nausea
  • Diarrhea
  • Vomiting
  • Constipation
  • Abdominal pain
  • Dyspepsia
  • Anorexia
  • Clostridium difficile colitis and diarrhea. This bacterium causes inflammation of large intestines. Early symptoms include flu like signs, bloating and abdominal pain.
  • Dry mouth
  • Flatulence
  • Taste perversion


Cardiovascular side effects have been observed in patients using levaquin. These include:

  • Prolonged QT interval
  • Torsade de pointes
  • Hypotension
  • Atrial fibrillation
  • Phlebitis
  • Postural hypotension
  • Aggravated hypertension
  • Vasodilation
  • Coronary thrombosis
  • Angina pectoris

The risk of arrhythmias in patients can be decreased by avoiding use in patients with hypokalemia, bradycardia or antiarrythmic agents.


Side effects on liver caused by levaquin medication are:

  • Increased level of hepatic enzymes
  • Hepatitis
  • Jaundice
  • Hepatocellular injury
  • Hepatic coma
  • Fatal hepatoxicity may occur rarely


Harmful side effects on kidneys observed in patients using levaquin are:

  • Interstitial nephritis
  • Renal calculi. These are kidney stones made of crystals.
  • Decreased urine
  • Abnormal renal function


Hematologic side effects of levaquin include:
  • Hemolytic anemia
  • Eosinophilia
  • Purpura
  • Thrombocytopenia
  • Leukopenia


Respiratory problems reported in patients undergoing levaquin therapy are:

  • Dyspnea. It means difficult or labored breathing.
  • Rhinitis
  • Pleural effusion
  • Hiccough
  • Hypoxia
  • Chronic obstructive airway disease
  • Allergic pneumonitis


Use of levaquin can cause metabolic disturbances. These include:

  • Severe hypoglycemia
  • Hypomagnesemia
  • Thirst
  • Gout
  • Hypernatremia
  • Elevated serum cholesterol
  • Fluid overload


Tendonitis and tendon rupture has frequently been reported in patients using levaquin. Levaquin induced tendonitis has abrupt onset with sharp stabbing pain occurring on walking and palpitation. Achilles tendon is most vulnerable but shoulder and hand involvement has been reported as well. Mostly tendon ruptures occur after two weeks of use or during prolonged therapy.

This tendon rupture occurs because of necrosis, ischemia and interstitial edema. Advanced age increases risk of levaquin induced tendon rupture. (15)

Nervous system

Adverse effects produced on nervous system by levaquin are:

  • Headache
  • Dizziness
  • Involuntary muscle contractions
  • Migraine
  • Stupor
  • Peripheral neuropathy


Psychiatric side effects of levaquin include:
  • Agitation
  • Anxiety
  • Nightmares
  • Impaired concentration
  • Confusion
  • Mania in some rare cases

Precautions and warnings

Before taking levaquin

Inform your doctor about your complete medical and medication history. Tell him if you have ever experienced allergic reaction to levofloxacin or any other fluoroquinolone. Hypersensitivity reaction to this drug has following manifestations:

  • Fever
  • Rash
  • Toxic epidermal necrolysis

Levaquin therapy must be discontinued immediately following appearance of allergic reaction.

  • If you are taking antacids containing aluminium hydroxide or magnesium hydroxide such as Maalox, Mylanta or Tums or vitamin supplements containing iron or zinc, take these medications two hours before or after taking levofloxacin to avoid drug interaction.
  • Inform doctor if you or anyone in your family suffers from cardiac problems especially prolonged QT interval. Levaquin could cause aggravation of your cardiac problems.
  • Levaquin can induce stupor, dizziness and confusion therefore do not drive or operate heavy machinery after taking your dose of levaquin.
  • Avoid using levaquin if you are suffering from myasthenia gravis because it increases muscular weakness.
  • In patients over 60 years of age levaquin should be prescribed with caution because risk of levaquin induced tendon rupture is high in this age group.
  • Levaquin can cause photosensitivity. Avoid stepping into harsh sunlight as blisters and sunburns can form over your skin. Apply sun block before stepping outdoors.
  • Get your renal and liver tests done once in a while to determine any adverse effects while using levaquin. If renal function disturbances or liver damage is indicated, discontinue use of this medication at once.
  • Avoid use of levaquin if you have suffered from seizures or epilepsy.
  • If you have any metabolic disturbances such as hypernatremia, hypokalemia, etc.

During pregnancy

No serious side effects of using levaquin have been reported during pregnancy but to be on the safe side, consult your doctor before taking up use of levaquin if you are pregnant. Immediately consult your physician or gynaecologist if you become pregnant during course of levaquin medication and do not continue taking this medicine unless your doctor gives you the go ahead.


Levaquin is secreted in breast milk and can cause harm to infant’s health therefore nursing mothers should avoid using this antibiotic.

Methods of administration

Levaquin is a prescription antibiotic available in market in many forms. These are:

  • Film coated oral tablets
  • Oral solutions
  • Pre mixed single use injection in flexible containers
  • Single use injection vials

How to take levaquin

Strictly follow dosage and schedule of medication prescribed by your physician. Also look at instructions on label of medicine for guidance.

Ingest levaquin tablets with water. Make sure to drink plenty of water while using this antibiotic. You may take the tablets after or before meals, it doesn’t make any difference.

Take oral solution after or before one or two hours of your meals. This form of levaquin must be taken on an empty stomach. Measure liquid medicine with a measuring device such as a cup or spoon.

Do not skip doses and do not give up course of treatment without completing it. Your infection will remain untreated this way and bacteria will become more resistant.

Do not share this medication with any other person especially kids even if they appear to have same symptoms as yours without consulting and getting them examined by a medical professional. Each age group requires its own specific dosage.

Store this medicine at room temperature and keep away from moisture and sunlight. Discard bottle of refrigerated oral solution if its expiry date has passed.

If you miss out on a dose, do not take two doses together for compensation. Else you might face risk of over dosage.

Comparison of Augmentin vs Zihtromax vs Levaquin

Now that you have got information about these three antibiotics, it is easy to compare them.


As far as the classification is concerned, these three antibiotics are classified as follows:
  • Augmentin belongs to penicillin group of antibiotics.
  • Zithromax is a macrolide.
  • Levaquin is a fluroquinolone.

Core component

Each of these three antibiotics has a different core component:
  • Augmentin is a combination antibiotic. Its core components are amoxicillin and cluvalanate.
  • Active ingredient of zithromax is azithromycin.
  • Core component of levaquin is levofloxacin.

Difference in mode of action

Each antibiotic acts a bit differently. Here is how:
  • Augmentin exerts its anti bacterial action by lysis and disintegration of bacterial cell wall.
  • Zithromax blocks bacterial cell protein synthesis.
  • Levaquin inhibits bacterial replication and eliminates bacteria.

Significant medical uses

These three antibiotics each have their own specific medical uses.

  • Augmentin is very efficient while treating respiratory infections caused by bacteria. It is considered first line therapy while treating throat infections. It is used to treat anthrax and can prevent fatal consequences of the disease. It is also widely used to treat middle ear infections.
  • Zithromax is useful in treating urinary tract infections and sexually transmitted diseases caused by bacteria. As far as treating respiratory infections is concerned, it is deemed as second line of treatment among antibiotics.
  • Levaquin is used to treat urinary tract infections and respiratory infections caused by Streptococcus pneumoniae.

Spectrum of action:

  • Augmentin is active against both gram negative and gram positive bacteria.
  • Zithromax mainly targets gram positive bacteria.
  • Levaquin is useful against both gram negative and gram positive bacteria.

Comparison of adverse (side) effects

While determining which antibiotic is most suitable for you, comparison of important side effects is very helpful depending upon your medical history.

  • Cluvalanate present in augmentin can cause cholestatic jaundice and hepatitis. Gastrointestinal disturbances such as nausea and abdominal cramps are quite frequent among patients using augmentin. Liver patients are most at risk of undesirable adverse effects while using this medicine.
  • Zithromycin prolongs QT interval and causes arrhythmias and ventricular tachycardia. Patients of heart disease are most vulnerable to harmful side effects of zithromax.
  • Levaquin can induce tendon tears and ruptures especially in elderly patients. It also aggravates muscle weakness in people suffering from myasthenia gravis. Patients with musculoskeletal disorders should use this medicine with great caution.

Use during pregnancy

The following precautins should be adopted when using these antibiotics during pregnancy:
  • Use of augmentin should be avoided during pregnancy.
  • Zithromax has been reported to be safe for pregnant women.
  • No harmful effects on pregnant women have been reported who used levaquin.

General precautions of use

Bear in mind the following:
  • Do not take augmentin with an empty stomach.
  • You may take zithromax before or after meals.
  • It does not matter if you take levaquin before or after meals.

Use when driving

As far as driving is concerned when using these antibiotics, bear in mind the following:
  • Augmentin induces stupor and should not be used prior to or during driving.
  • Zithromax is safe to use while driving.
  • Levaquin should not be used whilst driving or operating heavy machinery.


From this comparison, you will surely be able to determine which antibiotic most suits your medical needs and which one you should avoid keeping in view your medical profile and history. It will help you avoid unpleasant and possibly serious adverse effects that could be wrought upon your health. Furthermore, you will not unnecessarily use any antibiotic and thus save yourself from building up antibiotic resistance. Never take any antibiotics or any medical drugs without prior consultation of your physician and without his or her consent!

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Written by: Michal Vilímovský (EN)
Education: Physician
Article resources: See numbered references within the article
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Published: October 11, 2015 at 6:14 PM
Next scheduled update: October 11, 2017 at 6:14 PM
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