Levofloxacin (Levaquin) Dosing Guidelines
The typical dose of levofloxacin (Levaquin) for adults with normal renal function is 500 mg once daily or 750 mg once daily, depending on the type and severity of infection. 1
Standard Dosing Regimens
Adult Patients (Normal Renal Function)
- Standard regimen: 500 mg once daily for 7-14 days 2, 1
- High-dose, short-course regimen: 750 mg once daily for 5 days 2, 1, 3
These dosing regimens are appropriate for most common infections including:
- Community-acquired pneumonia
- Acute bacterial sinusitis
- Complicated urinary tract infections
- Acute pyelonephritis
- Skin and soft tissue infections
Dosage Adjustments for Special Populations
Renal Impairment
Dosage adjustment is required for patients with creatinine clearance less than 50 mL/min 1:
- For creatinine clearance 20-49 mL/min: Initial dose of 500 mg, then 250 mg once daily
- For creatinine clearance 10-19 mL/min: Initial dose of 500 mg, then 250 mg every 48 hours
- For patients on hemodialysis: No supplemental doses after dialysis are necessary 4
Pediatric Patients
- Generally contraindicated in children and adolescents under 18 years due to risk of arthropathy and effects on developing cartilage 2
- Reserved for specific FDA-approved indications or life-threatening infections with multidrug-resistant organisms when no alternatives exist 2
Important Administration Guidelines
Drug Interactions
- Antacids, sucralfate, metal cations (iron, zinc), or multivitamins containing these elements should be taken at least 2 hours before or after levofloxacin 1, 5
- This separation is critical as these agents can significantly decrease levofloxacin absorption 2
Administration
- Can be taken with or without food 1
- Maintain adequate hydration while taking levofloxacin to prevent crystalluria 1
Clinical Pearls and Precautions
- The high-dose, short-course (750 mg for 5 days) regimen maximizes concentration-dependent bactericidal activity and may reduce the potential for resistance development 3
- Levofloxacin has excellent bioavailability (nearly 100%), allowing for seamless transition between IV and oral therapy without dosage adjustment 5, 6
- Taking levofloxacin at doses higher than recommended (e.g., 500 mg four times daily) would significantly exceed the maximum recommended daily dose and increase risk of adverse effects 2
Common Adverse Effects
- Gastrointestinal: Nausea, bloating (0.5-1.8% of patients) 4
- Neurologic: Dizziness, insomnia, tremulousness, headache (0.5% of patients) 4
- Cutaneous: Rash, pruritus, photosensitivity (0.2-0.4% of patients) 4
Contraindications
- Pregnancy: Should be avoided due to potential teratogenic effects 4, 2
- Children: Generally contraindicated except in specific circumstances 2
Remember that levofloxacin is a broad-spectrum fluoroquinolone with excellent tissue penetration and should be used judiciously to minimize the development of resistance.