Levofloxacin Dosage and Duration for Various Infections
For most infections, levofloxacin should be dosed at 750 mg once daily for 5 days for respiratory infections like community-acquired pneumonia, or 250-500 mg once daily for 7-10 days for urinary tract infections, with specific adjustments based on infection type, severity, and renal function. 1, 2
Respiratory Tract Infections
Community-Acquired Pneumonia (CAP)
- Standard regimen: 750 mg once daily for 5 days 2, 3
- This higher dose, shorter course maximizes concentration-dependent bactericidal activity
- Reduces potential for resistance development
- Provides equivalent efficacy to 500 mg for 10 days 4
- Alternative regimen: 500 mg once daily for 7-14 days 2
- For severe CAP requiring hospitalization:
- Initial IV therapy with transition to oral when clinically stable
- For patients with risk factors for Pseudomonas aeruginosa:
- Combine levofloxacin with antipseudomonal β-lactam or aminoglycoside 2
Acute Bacterial Sinusitis
Acute Exacerbation of Chronic Bronchitis
- 500 mg once daily for 7 days 5
Urinary Tract Infections
Uncomplicated UTI
- 250 mg once daily for 10 days 1
Complicated UTI and Acute Pyelonephritis
Skin and Skin Structure Infections
Uncomplicated Infections
- 500 mg once daily for 7-10 days 5
Complicated Infections
- 750 mg once daily for 7-14 days 5
Dosage Adjustments for Renal Impairment 1
| Creatinine Clearance | Dosage |
|---|---|
| ≥50 mL/min | No adjustment needed |
| 20-49 mL/min | Initial dose: normal; then 50% of normal dose q24h |
| 10-19 mL/min | Initial dose: normal; then 50% of normal dose q48h |
| Hemodialysis or CAPD | Initial dose: normal; then 50% of normal dose q48h |
Important Clinical Considerations
Advantages of Levofloxacin
- Broad-spectrum activity against respiratory pathogens including S. pneumoniae (even penicillin-resistant strains), H. influenzae, M. catarrhalis, and atypical pathogens 2, 6
- Excellent bioavailability allowing easy transition from IV to oral therapy 4
- Once-daily dosing improves compliance 4
Cautions and Limitations
- Not recommended as first-line for uncomplicated UTIs - reserve for complicated cases or when other agents aren't appropriate 2
- Not appropriate for empiric CAP treatment in previously healthy adults - should be reserved for those with comorbidities or recent antibiotic exposure 2
- Ciprofloxacin is contraindicated for pneumonia due to inadequate pneumococcal coverage 2
- Resistance concerns: Use judiciously to prevent development of resistance 7
- Avoid in areas where fluoroquinolone resistance exceeds 10% for the targeted pathogen 2
Administration Considerations
- Can be taken without regard to food 1
- Should be administered at least 2 hours before or after antacids, sucralfate, metal cations, or multivitamins with zinc 1
- Maintain adequate hydration to prevent crystalluria 1
Pathogen-Specific Recommendations
Streptococcus pneumoniae
- For penicillin-resistant strains (MIC ≥2): Levofloxacin 750 mg daily 2
Legionella species
- Levofloxacin 750 mg IV/PO once daily 2
Pseudomonas aeruginosa
- Combination therapy recommended: Antipseudomonal β-lactam plus levofloxacin 750 mg daily 2
By following these evidence-based dosing recommendations, clinicians can optimize treatment outcomes while minimizing the risk of antimicrobial resistance development.