What is the recommended dose of levofloxacin for treating infections?

Levofloxacin Dosing Recommendations

The recommended dose of levofloxacin varies by indication, with standard adult dosing being 250 mg, 500 mg, or 750 mg administered orally once daily, depending on the type and severity of infection. 1

Standard Adult Dosing by Indication

• Community-Acquired Pneumonia:

  • 750 mg once daily for 5 days OR
  • 500 mg once daily for 7-14 days 2, 1

• Acute Bacterial Sinusitis:

  • 750 mg once daily for 5 days OR
  • 500 mg once daily for 10-14 days 1

• Acute Pyelonephritis:

  • 750 mg once daily for 5 days 1

• Complicated Urinary Tract Infections:

  • 750 mg once daily for 5 days OR
  • 250 mg once daily for 10 days 1, 3

• Uncomplicated Urinary Tract Infections:

  • 250 mg once daily for 3 days 3

• Chronic Bacterial Prostatitis:

  • 500 mg once daily for 28 days 1

• Complicated Skin and Skin Structure Infections:

  • 750 mg once daily for 7-14 days 1

• Tuberculosis:

  • Tablets (250 mg, 500 mg, 750 mg) once daily 2

Administration Considerations

• Levofloxacin can be administered without regard to food 1
• Available in tablet form and as an aqueous solution for intravenous injection, with oral and intravenous formulations being bioequivalent 4
• Should be administered at least two hours before or two hours after antacids containing magnesium, 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, as crystalluria has been reported with quinolones 1

Dosage Adjustments for Renal Impairment

• No adjustment necessary for patients with creatinine clearance ≥50 mL/min 1
• For patients with creatinine clearance <50 mL/min, dosage adjustment is required to avoid accumulation due to decreased clearance 1

Special Populations

• Pediatric Patients: Not generally recommended for children and adolescents due to concerns about effects on bone and cartilage growth 4
• Hepatic Disease: Drug levels are not affected by hepatic disease; can be used at standard doses but with caution 4
• Dialysis Patients: Levofloxacin is not cleared by hemodialysis, and supplemental doses after dialysis are not necessary 4

Clinical Efficacy

• High-dose, short-course regimens (750 mg once daily for 5 days) maximize concentration-dependent bactericidal activity and may reduce the potential for resistance development 3
• Levofloxacin has demonstrated good clinical efficacy in the treatment of respiratory tract infections, genitourinary infections, and skin and skin structure infections 5, 6
• For pyelonephritis, levofloxacin is an appropriate choice for therapy in patients not requiring hospitalization where the prevalence of resistance of community uropathogens to fluoroquinolones is not known to exceed 10% 2

Common Adverse Effects

• Most frequent adverse events include gastrointestinal disturbances (nausea, diarrhea), neurologic effects, and cutaneous reactions 4
• Compared to some other quinolones, levofloxacin has a low photosensitizing potential, and clinically significant cardiac and hepatic adverse events are rare 5

Important Precautions

• Monitor for potential adverse effects, particularly in children 4
• Avoid use in pregnancy due to potential teratogenic effects 4
• If the prevalence of fluoroquinolone resistance is thought to exceed 10% for urinary tract infections, an initial intravenous dose of a long-acting parenteral antimicrobial, such as 1 g of ceftriaxone or a consolidated 24-h dose of an aminoglycoside, is recommended 2