Levofloxacin Dosage for Pneumonia
For adults with pneumonia, levofloxacin should be administered at 750 mg once daily for 5-7 days as the preferred regimen, with a maximum daily dose of 750 mg. 1
Adult Dosing Recommendations
Community-Acquired Pneumonia (CAP)
- Standard regimen: 750 mg once daily for 5-7 days 1, 2
- This high-dose, short-course regimen maximizes concentration-dependent bactericidal activity
- Provides equivalent efficacy to the older 500 mg for 10 days regimen
- Better patient compliance due to shorter duration
Hospital-Acquired Pneumonia
- Standard regimen: 750 mg once daily for 7-15 days 3
- May require combination therapy with other antibiotics if Pseudomonas aeruginosa is suspected
Pediatric Dosing Recommendations
- Children 6 months to 5 years old: 16-20 mg/kg/day divided every 12 hours 4
- Children 5 to 16 years old: 8-10 mg/kg/day once daily 4
- Maximum daily dose: 750 mg (regardless of weight) 4
Duration of Therapy
- Uncomplicated pneumonia: 5-7 days 1, 5
- Complicated pneumonia: 7-14 days 1, 3
- Cavitary pneumonia: 2-4 weeks 1
Administration Considerations
- Oral levofloxacin is rapidly absorbed and bioequivalent to IV formulation 2, 6
- Patients can switch between IV and oral formulations without dosage adjustment 2
- Take with or without food
- Maintain adequate hydration during therapy to prevent crystalluria
Clinical Advantages of High-Dose, Short-Course Therapy
- Maximizes concentration-dependent killing 5
- Reduces potential for resistance development 5
- Improves patient adherence 2, 5
- More rapid symptom resolution, particularly fever 7
- Reduces total antimicrobial exposure 7
Special Populations
- Renal impairment: Dosage adjustment required
- CrCl 20-49 mL/min: 750 mg initially, then 750 mg every 48 hours
- CrCl 10-19 mL/min: 750 mg initially, then 500 mg every 48 hours
Monitoring
- Clinical improvement should be expected within 48-72 hours 1
- If no improvement occurs, reassess diagnosis and consider changing antibiotic regimen 1
Common Pitfalls
- Failing to adjust dose in renal impairment
- Using suboptimal dosing (500 mg daily) for severe infections
- Unnecessarily prolonged therapy beyond 5-7 days for uncomplicated cases
- Not considering local resistance patterns when selecting therapy
- Failing to narrow therapy once culture results are available
The 750 mg once-daily dosing regimen is supported by multiple studies showing equivalent or superior efficacy compared to traditional 500 mg regimens, with the advantage of shorter treatment duration and potentially reduced resistance development 2, 5, 7.