Pharmacokinetic and efficacy studies with levofloxacin were performed in the common marmoset (Callithrix jacchus) model of inhalational tularemia. Plasma levofloxacin pharmacokinetics were determined in six animals in separate single-dose and multidose studies. Plasma drug concentrations were analyzed using liquid chromatography-tandem mass spectrometry-electrospray ionization. On day 7 of a twice-daily dosing regimen of 40 mg/kg, the levofloxacin half-life, maximum concentration, and area under the curve in marmoset plasma were 2.3 h, 20.9 g/ml, and 81.4 g/liter/h, respectively. An efficacy study was undertaken using eight treated and two untreated control animals. Marmosets were challenged with a mean of 1.5 ؋ 10 2 CFU of Francisella tularensis by the airborne route. Treated animals were administered 16.5 mg/kg levofloxacin by mouth twice daily, based on the pharmacokinetic parameters, beginning 24 h after challenge. Control animals had a raised core body temperature by 57 h postchallenge and died from infection by day 5. All of the other animals survived, remained afebrile, and lacked overt clinical signs. No bacteria were recovered from the organs of these animals at postmortem after culling at day 24 postchallenge. In conclusion, postexposure prophylaxis with orally administered levofloxacin was efficacious against acute inhalational tularemia in the common marmoset. The marmoset appears to be an appropriate animal model for the evaluation of postexposure therapies.Francisella tularensis is a Gram-negative intracellular pathogen that is the causative agent of tularemia. The disease is prevalent in many countries in the northern hemisphere, including the United States (8), where the reported number of cases averages 100 to 200 annually (11). The pathogen is infectious by a number of routes, has a low infectious dose, and is readily transmitted by the airborne route and so is included on the CDC list of select agents that have potential to pose a major threat to public health and safety (http://emergency.cdc .gov/agent/agentlist-category.asp).Currently, the recommended preferred treatment for adults with tularemia is systemic gentamicin or streptomycin or, alternatively, doxycycline or ciprofloxacin for 14 to 21 days (5; http://www.hpa.org.uk/deliberate_accidental_releases/biological). In the case of a mass bioweapon attack, prophylaxis with orally administered ciprofloxacin or doxycycline twice daily is suggested (5; http://www.hpa.org.uk/deliberate_accidental _releases/biological). Fluoroquinolones such as ciprofloxacin and levofloxacin are attractive alternative antibiotics for tularemia, as they have good in vitro activity, have bactericidal effects, and can be administered orally (13). Levofloxacin has a broad spectrum of activity, a good safety record, and an oral bioavailability of over 99% (10), while single daily dosing gives it a further advantage over the more commonly used antibiotic ciprofloxacin. Murine studies indicate that intraperitoneal administration of levofloxacin is 100% effective agains...