What is the recommended dosage of Levaquin (levofloxacin) for the treatment of bronchopneumonia?

From the Guidelines

For bronchopneumonia, the recommended Levaquin (levofloxacin) dosage is 750 mg daily, as stated in the 2019 guidelines for the diagnosis and treatment of adults with community-acquired pneumonia 1. This dosage is recommended for outpatient adults with comorbidities, and it is effective against many respiratory pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and atypical organisms like Mycoplasma and Legionella. Some key points to consider when prescribing Levaquin include:

• The medication should be taken orally with or without food, though it's best to maintain consistent timing relative to meals.
• Adequate hydration is important while taking Levaquin to prevent crystalluria.
• Dosage adjustments are necessary for patients with renal impairment: for creatinine clearance 20-49 mL/min, use 500 mg initially followed by 250 mg daily; for clearance 10-19 mL/min, use 500 mg initially then 250 mg every 48 hours.
• Patients should complete the full course even if symptoms improve and report any tendon pain, as fluoroquinolones carry a risk of tendinopathy. It's also important to note that the optimal dosing strategy for fluoroquinolones involves optimizing peak drug plasma concentrations, and an approach that optimizes the dose within a nontoxic range should provide the highest probability of a favorable microbiologic and clinical response 1.

From the FDA Drug Label

Adult inpatients and outpatients with a diagnosis of community-acquired bacterial pneumonia were evaluated in 2 pivotal clinical studies In the first study, 590 patients were enrolled in a prospective, multicenter, unblinded randomized trial comparing levofloxacin 500 mg once daily orally or intravenously for 7 to 14 days to ceftriaxone 1 to 2 grams intravenously once or in equally divided doses twice daily followed by cefuroxime axetil 500 mg orally twice daily for a total of 7 to 14 days In the second study, 264 patients were enrolled in a prospective, multi-center, non-comparative trial of 500 mg levofloxacin administered orally or intravenously once daily for 7 to 14 days. To evaluate the safety and efficacy of the higher dose and shorter course of levofloxacin, 528 outpatient and hospitalized adults with clinically and radiologically determined mild to severe community-acquired pneumonia were evaluated in a double-blind, randomized, prospective, multicenter study comparing levofloxacin 750 mg, IV or orally, every day for five days or levofloxacin 500 mg IV or orally, every day for 10 days.

The recommended levofloxacin dosage for bronchopneumonia (also known as community-acquired pneumonia) is:

• 500 mg once daily orally or intravenously for 7 to 14 days 2
• 750 mg once daily orally or intravenously for 5 days 2

From the Research

Levaquin Dosage in Bronchopneumonia

• The recommended dosage of Levaquin (levofloxacin) for the treatment of community-acquired pneumonia, which includes bronchopneumonia, is 500mg once daily for 7-14 days or 750mg once daily for 5 days 3, 4, 5.
• A study published in 2004 found that a 750-mg, 5-day course of levofloxacin was at least as effective as a 500-mg, 10-day regimen for the treatment of atypical community-acquired pneumonia, including bronchopneumonia 6.
• Another study published in 2012 recommended levofloxacin for the treatment of community-acquired pneumonia, hospital-acquired pneumonia, and acute exacerbations of chronic bronchitis, with a high-dose (750 mg), short-course (5 days) therapy regimen offering improved treatment outcomes 7.
• The high-dose, short-course levofloxacin regimen maximizes its concentration-dependent bactericidal activity, decreases the potential for drug resistance, and has better patient compliance 4, 5.

Treatment Duration and Efficacy

• The efficacy and tolerability of levofloxacin 500 mg once daily for 10 days in patients with community-acquired pneumonia are well established 3, 5.
• A high-dose (750 mg), short-course (5 days) of once-daily levofloxacin has been approved for use in the USA in the treatment of community-acquired pneumonia, acute bacterial sinusitis, acute pyelonephritis, and complicated urinary tract infections 4.
• Levofloxacin can be used as a monotherapy in patients with community-acquired pneumonia, but combination therapy with anti-pseudomonal beta-lactam (or aminoglycoside) should be considered if Pseudomonas aeruginosa is the causative pathogen of the respiratory infection 5.