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The Policy VaultThe Policy Vault

Levofloxacin injectionCareFirst (Caremark)

Uncomplicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus

Initial criteria

  • Reserve levofloxacin injection for treatment of uncomplicated urinary tract infection in patients who have no alternative treatment options
  • Reserve levofloxacin injection for treatment of acute bacterial exacerbation of chronic bronchitis in patients who have no alternative treatment options
  • Reserve levofloxacin injection for treatment of acute bacterial sinusitis in patients who have no alternative treatment options
  • Appropriate culture and susceptibility tests should be performed before treatment when possible
  • Use only to treat or prevent infections proven or strongly suspected to be caused by susceptible bacteria