Levofloxacin Dosage for Urinary Tract Infections
For urinary tract infections (UTIs), levofloxacin should be dosed at 750 mg once daily for 5 days for complicated UTIs and acute pyelonephritis, or 250 mg once daily for 10 days for uncomplicated UTIs. 1, 2
Dosing Recommendations by UTI Type
Uncomplicated UTIs
- 250 mg orally once daily for 10 days for mild to moderate infections due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus 2, 3
- Clinical success rates of 92-93.3% and bacteriological eradication rates of 93.6-94.7% have been reported with this regimen 4
Complicated UTIs
- 750 mg orally or intravenously once daily for 5 days for infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis 2
- Alternative regimen: 250 mg orally once daily for 10 days for mild to moderate complicated UTIs due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa 2, 3
Acute Pyelonephritis
- 750 mg orally once daily for 5 days for infections caused by Escherichia coli, including cases with concurrent bacteremia 1, 2
- Alternative regimen: 250 mg orally once daily for 10 days 2
Evidence-Based Efficacy
- A randomized, double-blind, multicenter clinical trial comparing levofloxacin 750 mg once daily for 5 days with ciprofloxacin 400 mg IV/500 mg orally twice daily for 10 days in complicated UTIs and acute pyelonephritis showed comparable bacteriologic eradication rates 2
- The 5-day, high-dose regimen maximizes levofloxacin's concentration-dependent bactericidal activity and may reduce the potential for resistance development 5
- Levofloxacin distributes well in urinary tract tissues and achieves high urinary concentrations that exceed the MIC90 for most common uropathogens 6
Important Considerations
Antimicrobial Resistance
- Fluoroquinolone resistance should be <10% in the local community for empiric use of levofloxacin 1, 7
- If fluoroquinolone resistance is thought to exceed 10%, an initial intravenous dose of a long-acting parenteral antimicrobial (e.g., 1 g of ceftriaxone) is recommended before starting levofloxacin 1
Culture and Susceptibility Testing
- For complicated UTIs and pyelonephritis, a urine culture and susceptibility test should always be performed before initiating therapy 1, 7
- Therapy should be tailored based on culture results when available 1, 7
Special Populations
- For hospitalized patients with pyelonephritis, initial treatment with IV levofloxacin (750 mg once daily) is recommended with transition to oral therapy once clinically improved 1, 7
- For patients with renal impairment, dosage adjustment is necessary:
Advantages of Levofloxacin
- Once-daily dosing improves compliance 5
- High oral bioavailability allows for easy transition from IV to oral therapy without dosage adjustment 4
- Broad spectrum of activity against common uropathogens, including both Gram-positive and Gram-negative bacteria 6, 3
The 5-day, 750 mg once-daily regimen offers the advantages of shorter treatment duration with comparable efficacy to longer traditional regimens, potentially improving patient adherence and reducing the risk of resistance development 7, 5.