What is Levaquin (levofloxacin) 750mg twice a day?

From the Guidelines

Levaquin (levofloxacin) 750mg twice daily (BID) is not a standard dosing regimen and may increase the risk of adverse effects. The typical adult dosing for Levaquin 750mg is once daily, not twice daily, as stated in the guidelines for the treatment of pneumonia in Taiwan 1. Taking 750mg BID would result in a total daily dose of 1500mg, which exceeds the recommended maximum daily dose. Levaquin is a fluoroquinolone antibiotic that works by inhibiting bacterial DNA gyrase and topoisomerase IV, preventing bacterial DNA replication. Common indications include respiratory tract infections, urinary tract infections, skin infections, and certain types of pneumonia. The once-daily dosing is sufficient to maintain therapeutic drug levels due to the medication's pharmacokinetic properties, including its long half-life of approximately 6-8 hours.

Some key points to consider when prescribing Levaquin include:

• The recommended dose for Levaquin is 750mg once daily, as stated in the guidelines for the treatment of pneumonia in Taiwan 1.
• The use of Levaquin may be associated with an increased risk of adverse effects, such as tendon rupture, peripheral neuropathy, and QT interval prolongation.
• Levaquin is effective against a range of bacterial pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, as stated in the British Thoracic Society guideline for bronchiectasis in adults 1.
• The treatment duration for Levaquin varies depending on the specific infection being treated, but is typically 5-14 days, as stated in the guidelines for the treatment of pneumonia in Taiwan 1.

If you've been prescribed Levaquin 750mg BID, I recommend confirming this dosage with your healthcare provider or pharmacist as it may be an error. Common side effects include nausea, diarrhea, headache, and dizziness, while serious adverse effects can include tendon rupture, peripheral neuropathy, and QT interval prolongation. It's also important to note that Levaquin should be used cautiously in patients with risk or suspicion of tuberculosis, as it may delay the diagnosis of pulmonary tuberculosis and increase the risk of fluoroquinolone resistance, as stated in the guidelines for the treatment of pneumonia in Taiwan 1.

From the FDA Drug Label

Patients received levofloxacin doses of 750 mg once daily, 250 mg once daily, or 500 mg once or twice daily.

The FDA drug label does not provide information on a dosage of Levaquin (levofloxacin) 750mg twice a day.

From the Research

Overview of Levaquin (Levofloxacin) 750mg Twice a Day

• Levaquin (levofloxacin) is a fluoroquinolone antibacterial agent with a broad spectrum of activity against Gram-positive and Gram-negative bacteria and atypical respiratory pathogens 2, 3, 4, 5, 6.
• The standard dosage of levofloxacin for various infections is typically 500mg once daily for 10 days, but a high-dose (750 mg) short-course (5 days) of once-daily levofloxacin has been approved for use in the US in the treatment of community-acquired pneumonia (CAP), acute bacterial sinusitis, acute pyelonephritis, and complicated urinary tract infections 2, 5.

Efficacy and Tolerability

• Levofloxacin has been shown to be effective in the treatment of various infections, including CAP, acute exacerbations of chronic bronchitis, acute maxillary sinusitis, and uncomplicated and complicated urinary tract infections 3, 4, 6.
• The efficacy and tolerability of levofloxacin 500 mg once daily for 10 days in patients with CAP are well established, and a high-dose (750 mg), short-course (5 days) of once-daily levofloxacin has been shown to be noninferior to the 10-day regimen in CAP and acute bacterial sinusitis 2, 5.
• Levofloxacin is generally well tolerated, with the most frequently reported adverse events being nausea and diarrhea 3, 6.

Dosage and Administration

• The dosage of 750mg twice a day is not a standard recommended dosage for levofloxacin, as the typical dosage is 500mg once daily for 10 days or 750mg once daily for 5 days 2, 5.
• However, levofloxacin can be administered in a sequential intravenous to oral regimen, and the patients can switch between these formulations without dosage adjustment 4, 6.

Mechanism of Action and Resistance

• Levofloxacin acts on bacterial topoisomerase and has activity against a broad range of Gram-positive and Gram-negative organisms 3, 4.
• The high-dose, short-course levofloxacin regimen maximizes its concentration-dependent antibacterial activity and may reduce the potential for resistance to emerge 2, 5.