Levaquin vs. Bactrim for Pneumonia and Urinary Tract Infection: Important Differences and Potential Risks.

Key takeaways

Levofloxacin and sulfamethoxazole/trimethoprim (Bactrim, Septra) are both antibiotics, but they belong to different classes and treat infections differently. Levofloxacin is a fluoroquinolone antibiotic that works by blocking enzymes bacteria need to grow, while sulfamethoxazole/trimethoprim is a combination of a sulfonamide and an antifolate that stops bacteria from making folic acid which kills the bacteria. Levofloxacin is typically taken once daily and is used for more serious infections due to its risk of severe side effects like tendon rupture and nerve damage. In contrast, sulfamethoxazole/trimethoprim is usually taken twice daily and can treat a variety of infections, including UTIs and ear infections, but it isn't recommended during pregnancy. Both medications are available in generic forms, but levofloxacin has more serious warnings and is often reserved for cases where other antibiotics are not suitable.

Levofloxacin

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Sulfamethoxazole/trimethoprim

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Summary for Levaquin

Prescription only

Levofloxacin is a fluoroquinolone antibiotic. It can treat many types of bacterial infections, including pneumonia and urinary tract infections (UTIs). But because levofloxacin can cause serious side effects, such as tendon rupture and nerve damage, it's usually only prescribed for more serious infections or when safer options aren't available. Levofloxacin is taken by mouth, typically once daily. Some of the more common side effects of this medication include nausea, headache, and diarrhea. Levofloxacin is generic only, brand-name Levaquin is no longer available.

Indications for Levaquin

Adults only

Skin infections
Sinus infections
Pneumonia
Sudden worsening of chronic (long-term) bronchitis
Urinary tract infections (UTIs)
Kidney infections
Long-term prostate infections

Adults and children

Anthrax exposure through inhalation
Plague

Pros and Cons for Levaquin

Pros

Usually taken once per day
Available as tablets, oral liquid, and injection
Available as a lower-cost generic

Cons

Has many potentially serious side effects and risks (e.g, nerve issues, irregular heartbeat)
Might cause muscle, bone, and joint problems in children
Interacts with some antacids and multivitamins

Common Side Effects for Levaquin

Nausea (7%)
Headache (6%)
Diarrhea (5%)
Trouble sleeping (4%)

Warnings for Levaquin

Tendon inflammation and rupture
Effects on the brain, nerves, and mental health
Worsening of myasthenia gravis
Severe allergic and skin reactions
Liver damage
Severe blood vessel (aorta) damage
Diarrhea from Clostridioides difficile infection
Life-threatening abnormal heart rhythm (QT prolongation)
Muscle, bone, and joint problems in children
Sun and light sensitivity

Summary for Bactrim

Prescription only

Sulfamethoxazole/trimethoprim (sometimes known as SMZ/TMP) is a combination medication containing an antifolate and sulfa antibiotic. It's used to treat different types of infections, such as urinary tract infections (UTIs), ear infections, and lung infections. This antibiotic has two different brand names, Bactrim and Septra, and it's also available as a lower-cost generic. It's a tablet that's taken by mouth, typically twice daily for most types of infections. This antibiotic also comes as a suspension under the brand name Sulfatrim for people who can't swallow tablets and as an injection for people in the hospital. Common side effects include nausea, diarrhea, and rash.

Indications for Bactrim

Urinary tract infection (UTI)
Lower respiratory tract infection (e.g., Pneumocystis pneumonia, infections related to bronchitis)
Diarrhea caused by Shigella (shigellosis)
Travelers' diarrhea - tablet or liquid only
Ear infections - tablet or liquid only

Pros and Cons for Bactrim

Pros

Treats many types of bacterial infections
Can be given to children as young as 2 months old to treat certain infections
Available as a lower-cost generic

Cons

Can upset your stomach and make your skin more sensitive to the sun
Not the best choice for people with liver or kidney problems
Not recommended if you're pregnant
Can't take if you have a sulfa allergy

Common Side Effects for Bactrim

Nausea
Vomiting
Diarrhea
Loss of appetite
Rash
Hives
Skin sensitivity to sun or light

Warnings for Bactrim

Not for use during pregnancy
Severe allergic reactions and skin reactions
Low platelet counts and risk for bleeding
Diarrhea from Clostridioides difficile infection
Low sodium levels and high potassium levels
Blood cell-related problems
Problems with processing phenylalanine - for people with phenylketonuria (PKU) only