What is the difference between ofloxacin and levofloxacin?

Antibacterial activity
Similar but different antimicrobial spectra:
Both of them have good antibacterial effects on gram-negative bacteria such as Escherichia coli, Klebsiella pneumoniae, Proteus, etc., and can treat diseases caused by these bacteria such as urinary and reproductive system infections and intestinal infections.
The antibacterial activity of levofloxacin against gram-positive bacteria such as Staphylococcus aureus and Streptococcus pneumoniae is usually stronger than that of levofloxacin. For example, in the treatment of community-acquired pneumonia, levofloxacin can more effectively inhibit the growth of Streptococcus pneumoniae and reduce the severity of infection.
Different antimicrobial strength:
The antibacterial activity of levofloxacin is about twice that of levofloxacin. This is because levofloxacin is the left-handed component of ofloxacin, and the right-handed component has almost no antibacterial activity, so at the same dose, levofloxacin can play a more effective antibacterial effect.
pharmacokinetics
Absorption aspect:
Ofloxacin is well absorbed after oral administration, but is affected by food, and eating may reduce the speed and extent of its absorption.
Levofloxacin is absorbed quickly and completely by mouth, and is less affected by food, and can be taken on an empty stomach or after meals. For example, patients taking levofloxacin on an empty stomach can reach the peak blood concentration in about 1-2 hours, and the absorption efficiency is relatively stable.
Distribution:
Both can be widely distributed in all tissues and fluids of the body, including the lungs, kidneys, prostate, bile and so on.
Levofloxacin is more penetrating in some tissues, such as the relatively high concentration of the drug in lung tissue, which makes it potentially advantageous in the treatment of respiratory infections.
Metabolic and excretory aspects:
Ofloxacin is excreted mainly by the kidneys and partially metabolized in the liver.
Levofloxacin is mainly excreted from the urine in its original form, its metabolic process is relatively simple, and the residence time of the drug in the body may be relatively short, which can quickly clear the drug for patients with normal kidney function and reduce the risk of drug accumulation in the body.
Clinical application
The applicable disease types are generally the same, but there are some focuses:
They are used to treat infections caused by sensitive bacteria, such as urinary and reproductive system infections, respiratory system infections, digestive system infections, etc.
Due to its strong antibacterial activity against Gram-positive bacteria and Streptococcus pneumoniae, and its high concentration in lung tissue, levofloxacin is more commonly used in the treatment of respiratory infections such as community-acquired pneumonia.
Ofloxacin is also used in some complex mixed infections, such as some genitourine infections that have Gram-negative bacteria and may involve other bacteria.
Adverse reaction
Both types of adverse reactions are similar, and may include gastrointestinal reactions (such as nausea, vomiting, diarrhea), central nervous system reactions (such as headache, dizziness), and allergic reactions (such as rash, itching).
However, due to the strong antibacterial activity of levofloxacin, the risk of adverse reactions may be increased at high doses. For example, in the treatment of serious infections, the use of high doses of levofloxacin may be more prone to central nervous system excitation symptoms.