Levofloxacin Dosing for Ear Infections
For ear infections, levofloxacin should be administered at 500 mg once daily for 10 days in adults, while children should receive 10 mg/kg twice daily for 10 days. 1
Adult Dosing
Acute Otitis Media/Ear Infections
- 500 mg once daily for 10 days is the standard recommended dose for adults with ear infections 2
- For severe infections, a high-dose short-course regimen of 750 mg once daily for 5 days may be considered as an alternative 3
Administration Options
- Levofloxacin is available in tablet form (250 mg, 500 mg, 750 mg) and as an aqueous solution (500 mg vials) for intravenous injection 2
- Oral and intravenous formulations are bioequivalent, allowing for seamless transition between administration routes based on clinical needs 4
- Oral levofloxacin is rapidly absorbed with nearly 100% bioavailability 4
Pediatric Dosing
Acute Otitis Media
- For children with ear infections, particularly those with recurrent or persistent acute otitis media: 10 mg/kg twice daily for 10 days 1
- Important caution: Long-term use of levofloxacin in children and adolescents has not been approved due to concerns about effects on bone and cartilage growth 2
- However, most experts agree that the drug should be considered for children with infections caused by resistant organisms 2
Special Populations
Renal Impairment
- Dosage adjustment (750-1000 mg three times a week) is recommended if creatinine clearance is less than 50 ml/minute 2
- Levofloxacin is not cleared by hemodialysis; supplemental doses after dialysis are not necessary 2
Hepatic Impairment
- Drug levels are not affected by hepatic disease 2
- Can be used at standard doses in patients with liver disease, but should be used with caution 2
Clinical Considerations
Efficacy
- Levofloxacin has excellent activity against common respiratory pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 1
- In studies of children with otitis media, levofloxacin achieved bacterial eradication rates of 88% overall and 90% in children ≤24 months of age 1
Potential Adverse Effects
- Most common adverse effects include gastrointestinal disturbances (nausea, bloating) in 0.5-1.8% of patients 2
- Neurologic effects such as dizziness, insomnia, tremulousness, and headache occur in 0.5% of patients 2
- Cutaneous reactions including rash, pruritus, and photosensitivity occur in 0.2-0.4% of patients 2
- Vomiting (4%) is the most common treatment-limiting adverse event in children 1
Important Precautions
- Avoid use in pregnancy due to potential teratogenic effects 2
- Antacids and other medications containing divalent cations markedly decrease absorption of fluoroquinolones; levofloxacin should not be administered within 2 hours of such medications 2
- Monitor for potential adverse effects, particularly in children 2
Comparative Efficacy
- Levofloxacin has a broad spectrum of activity against both Gram-positive and Gram-negative bacteria and atypical respiratory pathogens 5
- It is active against both penicillin-susceptible and penicillin-resistant Streptococcus pneumoniae 5
- The high-dose, short-course regimen maximizes concentration-dependent bactericidal activity and may reduce the potential for resistance development 3