From the Guidelines
For community-acquired pneumonia in adults, the standard levofloxacin dose is 750 mg once daily for 5 days, as this dose is designed to overcome the most common mechanism for the development of fluoroquinolone resistance 1.
Key Considerations
- The dose of levofloxacin for hospital-acquired pneumonia is also 750 mg once daily, but the duration of treatment may be extended to 7-14 days, depending on the clinical response and the results of microbiologic tests 1.
- Patients with renal impairment require dose adjustments: for creatinine clearance 20-49 mL/min, use 750 mg every 48 hours or 500 mg daily; for clearance 10-19 mL/min, use 750 mg initially then 500 mg every 48 hours, or 500 mg initially then 250 mg daily 1.
- Levofloxacin is effective against common pneumonia pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and atypical organisms like Mycoplasma and Legionella, by inhibiting bacterial DNA gyrase and topoisomerase IV, preventing DNA replication 1.
Important Safety Information
- Patients should complete the full course of levofloxacin even if symptoms improve, and report any tendon pain, as fluoroquinolones carry a risk of tendinopathy 1.
- The use of levofloxacin in children has been studied prospectively, and it has been shown to be effective in the treatment of community-acquired pneumonia, but its use in this population should be carefully considered due to the potential risks of fluoroquinolone resistance and other adverse effects 1.
From the FDA Drug Label
1.2 Community-Acquired Pneumonia: 7 to 14 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of community-acquired pneumonia due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae (including multi-drug-resistant Streptococcus pneumoniae [MDRSP]), Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydophila pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae [see Dosage and Administration (2.1) and Clinical Studies (14.2)].
14.2 Community-Acquired Pneumonia: 7 to 14 Day Treatment Regimen 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
The recommended dose of Levofloxacin for pneumonia is 500 mg once daily orally or intravenously for 7 to 14 days 2.
From the Research
Recommended Dose of Levofloxacin for Pneumonia
The recommended dose of Levofloxacin for pneumonia is:
- 500 mg once daily for 10 days 3, 4, 5
- 750 mg once daily for 5 days, which is a high-dose, short-course regimen 3, 5, 6, 7
Efficacy of Levofloxacin Regimens
Both regimens have been shown to be effective in treating community-acquired pneumonia (CAP), with clinical success rates ranging from 86% to 96% 4 and microbiologic eradication rates of 88% to 95% 4. The high-dose, short-course regimen has been demonstrated to be noninferior to the 10-day regimen in CAP 5, 7 and may provide more rapid symptom resolution 6.
Considerations for Treatment
Levofloxacin can be used as monotherapy in patients with CAP, but combination therapy with anti-pseudomonal beta-lactam (or aminoglycoside) should be considered if Pseudomonas aeruginosa is the causative pathogen 3. The choice of regimen may depend on factors such as the severity of the infection, the presence of underlying conditions, and the potential for resistance to emerge 5.