What is the dose and frequency for levofloxacin (Levaquin) in treating infections?

Levofloxacin Dosing Guidelines

The standard dosage of levofloxacin is 250 mg, 500 mg, or 750 mg administered orally once daily (every 24 hours), with the specific dose determined by the type and severity of infection being treated. 1

Standard Dosing by Indication

• Community-acquired pneumonia (CAP): 750 mg once daily for 5 days (high-dose, short-course regimen) 2, 3, 4
• Acute bacterial sinusitis: 750 mg once daily for 5 days 2, 5
• Acute exacerbations of chronic bronchitis: 500 mg once daily for 7 days 2
• Complicated urinary tract infections: 750 mg once daily for 5 days 5
• Acute pyelonephritis: 750 mg once daily for 5 days 5
• Nosocomial pneumonia: 750 mg once daily for 7-14 days 6
• Chronic bacterial prostatitis: 500 mg once daily for 28 days 6
• Uncomplicated skin infections: 500 mg once daily for 7-10 days 6
• Complicated skin infections: 750 mg once daily for 7-14 days 6

Dosage Adjustments for Renal Impairment

• Normal renal function (CrCl ≥50 mL/min): No adjustment necessary 1
• Renal impairment (CrCl <50 mL/min): Dosage adjustment required to prevent drug accumulation 1
• Severe renal impairment or dialysis: Consultation with a nephrologist is advised 2

Administration Guidelines

• Levofloxacin tablets can be administered without regard to food 1
• Should be administered at least two hours before or two hours after antacids containing magnesium or aluminum, sucralfate, metal cations such as iron, and multivitamin preparations with zinc 1
• Adequate hydration should be maintained to prevent the formation of highly concentrated urine 1

Clinical Considerations

• The high-dose (750 mg), short-course (5 days) regimen maximizes concentration-dependent bactericidal activity and may reduce the potential for resistance development 5, 4
• This regimen offers better compliance due to shorter treatment duration and convenient once-daily administration 5
• Oral levofloxacin is rapidly absorbed and bioequivalent to the intravenous formulation, allowing patients to transition between formulations 5, 4
• For severe CAP requiring ICU care, some experts recommend 750 mg IV once daily or 500 mg IV twice daily, often in combination with other antibiotics 3
• For infections caused by Pseudomonas aeruginosa, levofloxacin should be combined with antipseudomonal beta-lactams 3, 4

Pediatric Dosing

• The use of fluoroquinolones in children and adolescents has not been widely approved due to concerns about effects on bone and cartilage growth 7
• However, most experts agree that levofloxacin should be considered for children with tuberculosis caused by organisms resistant to both isoniazid and rifampin 7
• The optimal dose for children is not well established 7

Duration of Therapy

• Treatment should generally not exceed 8 days in responding patients 2, 3
• Response to treatment should be monitored using clinical criteria including body temperature, respiratory and hemodynamic parameters 3

Cautions and Monitoring

• Previous exposure to fluoroquinolones in the recent past may preclude the use of levofloxacin due to potential resistance development 2
• Levofloxacin is generally well tolerated, with the most common adverse events being nausea and diarrhea 6
• Unlike some other fluoroquinolones, levofloxacin has a low photosensitizing potential and rarely causes significant cardiac or hepatic adverse events 6