What is the dose of Levofloxacin (levofloxacin) for a 74-year-old male with chronic prostatitis (inflammation of the prostate) and potentially Impaired renal function?

From the Guidelines

For a 74-year-old male with prostatitis, the recommended dose of levofloxacin is 500 mg orally once daily for 28 days for chronic bacterial prostatitis, or 750 mg once daily for 14 days for acute bacterial prostatitis, with dose adjustment necessary for patients with renal impairment, as indicated by creatinine clearance levels 1. When considering the dose of levofloxacin for this patient, it's crucial to assess renal function, as older adults are more likely to have impaired renal function.

• For creatinine clearance 50–80 mL/min, a 500-mg loading dose, then 250 mg every 24 hours is recommended 1.
• For creatinine clearance <50 mL/min, a 500-mg loading dose, then 250 mg every 48 hours is recommended 1. It's essential to ensure adequate hydration (at least 1.5 liters of fluid daily) while taking levofloxacin to prevent crystalluria.
• Monitor for side effects, which are more common in elderly patients, including tendon inflammation or rupture, QT prolongation, CNS effects (confusion, dizziness), and Clostridium difficile-associated diarrhea. Levofloxacin is effective for prostatitis because it achieves good penetration into prostatic tissue and has activity against common causative organisms, including gram-negative bacteria and some gram-positive pathogens.
• However, fluoroquinolone resistance is increasing, so culture and sensitivity testing should guide therapy whenever possible 1.

From the FDA Drug Label

The primary efficacy endpoint was microbiologic efficacy in microbiologically evaluable patients. A total of 136 and 125 microbiologically evaluable patients were enrolled in the levofloxacin and ciprofloxacin groups, respectively The microbiologic eradication rate by patient infection at 5 to 18 days after completion of therapy was 75% in the levofloxacin group and 76.8% in the ciprofloxacin group (95% CI [-12.58,8. 98] for levofloxacin minus ciprofloxacin). Adult patients with a clinical diagnosis of prostatitis and microbiological culture results from urine sample collected after prostatic massage (VB3) or expressed prostatic secretion (EPS) specimens obtained via the Meares-Stamey procedure were enrolled in a multicenter, randomized, double-blind study comparing oral levofloxacin 500 mg, once daily for a total of 28 days to oral ciprofloxacin 500 mg, twice daily for a total of 28 days.

The recommended dose of levofloxacin for a 74-year-old male with prostatitis is 500 mg once daily for 28 days 2.

• Dose adjustment is not necessary based on age alone 2.
• However, it is essential to consider the patient's renal function and adjust the dose accordingly, as levofloxacin is primarily excreted through the kidneys 2.
• The patient's renal function should be assessed before initiating treatment, and the dose should be adjusted if necessary to avoid accumulation of the drug 2.

From the Research

Dosage of Levofloxacin for Prostatitis

The dosage of levofloxacin for a 74-year-old male with prostatitis is typically 500 mg once daily for 28 days 3. This dosage has been shown to be effective in treating chronic bacterial prostatitis (CBP) caused by susceptible pathogens 3, 4.

Efficacy of Levofloxacin

The efficacy of levofloxacin in treating CBP has been demonstrated in several studies:

• A study published in 2008 found that levofloxacin 500 mg once daily for 28 days had a clinical success rate of 92% at 5-12 days post-treatment 3.
• A study published in 2019 found that levofloxacin 500 mg per day for 4 weeks had a pathogen eradication rate of 79% as a single agent and 87.8% when combined with azithromycin 4.
• Another study published in 2005 found that levofloxacin 500 mg daily for 28 days had a microbiological eradication rate of 90.9% in patients with normalized post-therapy PSA 5.

Comparison with Other Treatments

Levofloxacin has been compared to other treatments for CBP:

• A study published in 2010 found that trimethoprim/sulfamethoxazole had comparable response rates to levofloxacin 6.
• A study published in 1991 found that ciprofloxacin 500 mg twice daily for two weeks had a eradication rate of 70% in patients with refractory CBP 7.

Key Points

• Levofloxacin 500 mg once daily for 28 days is a common dosage for treating CBP.
• The efficacy of levofloxacin in treating CBP has been demonstrated in several studies.
• Levofloxacin has been compared to other treatments for CBP, including trimethoprim/sulfamethoxazole and ciprofloxacin.