Levofloxacin Dosage for Adults with CSOM
For adults with chronic suppurative otitis media (CSOM), the recommended dosage of levofloxacin is 500 mg orally once daily for 7-10 days. 1
Dosage Information
Levofloxacin is available in the following oral formulations:
- Tablets: 250 mg, 500 mg, and 750 mg 1
The standard adult dosing for most infections is 500 mg once daily, with duration depending on the specific infection being treated. For severe or complicated infections, the dose may be increased to 750 mg once daily 1.
Administration Guidelines
- Levofloxacin can be taken without regard to food 1
- Should be administered at least 2 hours before or 2 hours after:
- Antacids containing magnesium or aluminum
- Sucralfate
- Metal cations (e.g., iron)
- Multivitamin preparations with zinc
- Didanosine products 1
Special Considerations
Renal Adjustment
- No dosage adjustment needed for creatinine clearance ≥50 mL/min
- For patients with creatinine clearance <50 mL/min, dosing frequency should be reduced 1:
- CrCl 20-49 mL/min: 500 mg initially, then 250 mg every 24 hours
- CrCl 10-19 mL/min: 500 mg initially, then 250 mg every 48 hours
Hydration
- Adequate hydration should be maintained during treatment to prevent crystalluria 1
Treatment Duration
While specific guidelines for CSOM with levofloxacin are limited, fluoroquinolones are generally prescribed for 7-10 days for most infections. For complicated infections, treatment may extend to 14 days 2, 3.
Clinical Efficacy
Levofloxacin has demonstrated broad-spectrum activity against both Gram-positive and Gram-negative bacteria, making it effective against common pathogens involved in CSOM 2. It has good tissue penetration, which is important for treating infections of the middle ear 4.
Common Pitfalls and Caveats
Resistance concerns: Fluoroquinolone resistance is increasing in some regions. Consider local resistance patterns when prescribing 5.
Adverse effects: Monitor for tendinitis and tendon rupture, which are rare but serious adverse effects of fluoroquinolones 1.
Drug interactions: Avoid concurrent administration with medications that can prolong QT interval 1.
Patient education: Advise patients to complete the full course of antibiotics even if symptoms improve before completion to prevent resistance development.
Alternative therapy: If patient has contraindications to fluoroquinolones or treatment failure occurs, consider culture-guided alternative antibiotics.