What are the recommended doses of Levofloxacin (Levofloxacin) for adults and pediatric patients?

Levofloxacin Dosing for Adults and Pediatric Patients

For adults, levofloxacin is dosed at 500-750 mg once daily, while pediatric dosing is 8 mg/kg every 12 hours (not exceeding 250 mg per dose) for children 6 months to 17 years old. 1

Adult Dosing

Standard Adult Dosing

• Standard dose: 500 mg once daily 1
• High-dose regimen: 750 mg once daily 2
• Treatment duration: Typically 5-14 days depending on infection type and severity 3

Adult Dosing by Indication

• Community-acquired pneumonia: 500 mg once daily for 7-14 days or 750 mg once daily for 5 days 3
• Urinary tract infections:
  • Uncomplicated: 250 mg once daily for 3 days 4
  • Complicated/pyelonephritis: 250 mg once daily for 7-10 days 4
• Tuberculosis (when used as second-line agent): 500-1000 mg daily 5
• Anthrax post-exposure prophylaxis: 500 mg every 24 hours (as second-line agent when ciprofloxacin cannot be used) 5

Pediatric Dosing

General Pediatric Considerations

• Levofloxacin use in children is limited due to concerns about effects on bone and cartilage growth 5
• Should only be used when benefits outweigh risks, particularly for serious infections with limited treatment options 5

Pediatric Dosing Guidelines

• Children 6 months to 5 years: 8 mg/kg every 12 hours (maximum 250 mg per dose) 5, 1
• Children 5 to 16 years: 8-10 mg/kg once daily (maximum 750 mg per dose) 5, 1
• Children >16 years: Adult dosing applies

Pediatric Dosing by Indication

• Community-acquired pneumonia: 16-20 mg/kg/day divided every 12 hours for children 6 months to 5 years; 10 mg/kg/day once daily for children 5 years and older (maximum 750 mg per dose) 5
• Anthrax post-exposure prophylaxis: 16 mg/kg/day divided every 12 hours (maximum 250 mg per dose) 5

Special Populations and Considerations

Renal Impairment

• Dose adjustment required in patients with creatinine clearance <50 mL/min 6
• Dosing frequency should be reduced rather than dose amount 5

Safety Considerations

• Adults: Safety well-established for treatment durations up to 28 days; limited data for extended use up to 60 days 1
• Pediatric patients: Safety not established for treatment durations >14 days 1
• Increased risk of musculoskeletal adverse events in pediatric patients 1

Important Precautions

• Avoid levofloxacin in patients with multiple sclerosis due to potential neurological adverse effects 7
• Levofloxacin should not be used as first-line therapy in children; reserve for serious infections when other options are unavailable 5
• Fluoroquinolone resistance may increase with expanded use, so appropriate stewardship is essential 5
• Bioavailability approaches 100%, allowing for seamless transition between IV and oral formulations 6

When prescribing levofloxacin, always consider the risk-benefit ratio, particularly for pediatric patients and those with underlying neurological conditions. Fluoroquinolones should be reserved for infections where alternative agents are not suitable or effective to minimize the development of resistance.