Levofloxacin (Levaquin) Dosing Recommendations
The standard recommended dose of levofloxacin for adults with normal renal function is 500 mg once daily for most infections, with a higher dose of 750 mg once daily for severe infections, and a lower dose of 250 mg once daily for uncomplicated urinary tract infections. 1
Adult Dosing by Infection Type
Standard Infections (500 mg once daily)
- Community-acquired pneumonia (7-14 days)
- Acute bacterial sinusitis (10-14 days)
- Acute bacterial exacerbation of chronic bronchitis
- Complicated urinary tract infections (7-10 days)
- Acute pyelonephritis
Severe Infections (750 mg once daily)
- Nosocomial pneumonia
- Complicated skin and skin structure infections (7-14 days)
- Community-acquired pneumonia (5 days with high-dose, short-course regimen)
Uncomplicated Infections (250 mg once daily)
- Uncomplicated urinary tract infections (3 days)
Pediatric Dosing
- Levofloxacin is generally not recommended for children and adolescents under 18 years due to concerns about effects on bone and cartilage growth 2
- When benefits outweigh risks (such as in drug-resistant tuberculosis), children may receive levofloxacin at doses of:
- 16 mg/kg/day divided every 12 hours (not to exceed 250 mg per dose) 2
Renal Dosage Adjustments
For patients with impaired renal function, dose adjustment is necessary:
| Creatinine Clearance | Dosage Adjustment |
|---|---|
| ≥50 mL/min | No adjustment needed |
| 20-49 mL/min | Initial dose: 500 mg, then 250 mg every 24 hours |
| 10-19 mL/min | Initial dose: 500 mg, then 250 mg every 48 hours |
| Hemodialysis | No supplemental doses needed after dialysis [2] |
Administration Considerations
- Can be taken with or without food 1
- Must be taken at least 2 hours before or 2 hours after antacids, sucralfate, metal cations (iron), or multivitamins with zinc 1
- Ensure adequate hydration to prevent crystalluria 1
Special Populations
- Pregnant women: Should be avoided in pregnancy due to potential teratogenic effects 2
- Multiple sclerosis patients: Should be avoided due to potential neurological adverse effects that could exacerbate MS symptoms 3
Clinical Pearls and Pitfalls
- The high-dose, short-course regimen (750 mg for 5 days) maximizes concentration-dependent bactericidal activity and may reduce the potential for resistance development 4
- Levofloxacin has excellent bioavailability (approaching 100%), allowing for easy transition between IV and oral formulations 5
- Common adverse effects include nausea and diarrhea; neurologic effects (dizziness, insomnia, tremulousness, headache) occur in approximately 0.5% of patients 2, 3
- Levofloxacin has a lower photosensitizing potential compared to some other fluoroquinolones 6
Antimicrobial Considerations
- Levofloxacin demonstrates broad-spectrum activity against Gram-positive and Gram-negative bacteria, including penicillin-resistant Streptococcus pneumoniae 6
- For urinary tract infections, levofloxacin achieves high urinary concentrations after a 250 mg oral dose, exceeding the MIC90 for typical uropathogens 7
- When treating tuberculosis, levofloxacin is considered a second-line agent when first-line agents cannot be used due to resistance or intolerance 2
Always consider local antimicrobial resistance patterns when selecting levofloxacin for empiric therapy, as resistance rates may vary by region and infection type.