What is the recommended dosing of Levaquin (levofloxacin) for diverticulitis?

Levofloxacin Dosing for Diverticulitis

For diverticulitis treatment in adults, levofloxacin should be dosed at 500-750 mg once daily for 7 days, with appropriate adjustments for renal function if needed. 1, 2

Recommended Dosing Regimen

Standard Dosing

• Adult dose: 500-750 mg once daily 2
• Duration: 7 days 1, 3
• Administration: Can be given orally or intravenously with equivalent bioavailability 4

Renal Adjustment

• For creatinine clearance <50 mL/min: Reduce to 750-1000 mg three times weekly 2
• Not cleared by hemodialysis; supplemental doses after dialysis are not necessary 2

Clinical Considerations for Diverticulitis Treatment

Antibiotic Selection

• Levofloxacin is typically combined with metronidazole for diverticulitis to provide adequate anaerobic coverage 5
• Alternative regimen: Amoxicillin-clavulanate monotherapy, which may have a lower risk of C. difficile infection in patients over 65 years 5

Treatment Approach Based on Disease Severity

1. Uncomplicated diverticulitis (WSES stage 0):

   • Antibiotics may be avoided in immunocompetent patients without systemic manifestations 2

2. Localized complicated diverticulitis (WSES stage 1a):

   • Antibiotic therapy is recommended for patients with pericolic air bubbles or small amounts of pericolic fluid 2
   • Levofloxacin 500-750 mg daily + metronidazole 500 mg TID is an appropriate regimen 1, 3

Administration Considerations

• Oral absorption is very rapid and complete (nearly 100% bioavailability) 4
• Food has minimal effect on absorption 4
• Administer at least 2 hours before or after antacids containing aluminum, magnesium, or iron supplements to avoid decreased absorption 2, 4

Monitoring and Safety

Potential Adverse Effects

• Gastrointestinal: Nausea and bloating (0.5-1.8% of patients) 2
• Neurologic: Dizziness, insomnia, tremulousness, headache (0.5% of patients) 2
• Cutaneous: Rash, pruritus, photosensitivity (0.2-0.4% of patients) 2
• Rare but serious: Orofacial dyskinesia, particularly in elderly patients with renal insufficiency 6

Monitoring Parameters

• Baseline renal function tests before initiating therapy
• Clinical response within 4-7 days 3
• Monitor closely for neurological side effects, especially in elderly patients and those with renal impairment 6

Important Precautions

• Pregnancy: Avoid use due to potential teratogenic effects 2
• Hepatic disease: No dosage adjustment needed; drug levels not affected by hepatic disease 2
• Drug interactions: Avoid concurrent administration with divalent cation-containing products (separate by at least 2 hours) 2, 4
• Elderly patients: Monitor closely for CNS toxicities, particularly with renal insufficiency 6

Follow-up

• Clinical reassessment within 4-7 days after starting treatment to confirm symptom improvement 3
• Consider colonoscopy 6-8 weeks after resolution of acute symptoms if not performed within the past year 1