What is the dose of Levofloxacin (a fluoroquinolone antibiotic) for a patient with normal renal function?

Levofloxacin Dosing for Patients with Normal Renal Function

For patients with normal renal function (creatinine clearance ≥50 mL/min), the standard dose of levofloxacin is 500 mg administered orally once daily. 1

Standard Dosing Guidelines

• The FDA-approved dosing for levofloxacin in adults with normal renal function (creatinine clearance ≥50 mL/min) is 250 mg, 500 mg, or 750 mg administered orally every 24 hours, depending on the type and severity of infection 1
• For most common bacterial infections, 500 mg once daily is the standard dose 1, 2
• For more severe infections, a high-dose regimen of 750 mg once daily may be used 2
• Levofloxacin can be administered without regard to food 1

Formulations and Administration

• Levofloxacin is available in tablet form (250 mg, 500 mg, 750 mg) and as an aqueous solution (500 mg) for intravenous administration 3
• Oral levofloxacin is rapidly absorbed with bioavailability approaching 100%, making oral and intravenous formulations bioequivalent 4
• Patients can transition between oral and intravenous formulations when clinically appropriate 5
• Adequate hydration should be maintained to prevent crystalluria 1

Important Administration Considerations

• Levofloxacin 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, 4
• These agents can significantly decrease levofloxacin absorption when administered concurrently 4

Special Considerations

• For tuberculosis treatment, levofloxacin doses of 500-1000 mg daily are recommended for patients with normal renal function 3
• The pharmacokinetics of levofloxacin are not significantly affected by age, gender, or race when differences in renal function and body mass are accounted for 4
• Levofloxacin is not significantly affected by hepatic disease, and no dose adjustment is necessary for patients with liver dysfunction 6

Monitoring

• Patients should be monitored for potential adverse effects, which most commonly include gastrointestinal disturbances and central nervous system effects 7
• For prolonged therapy, monitoring for rare but serious adverse effects such as tendinopathy is recommended 2

Common Pitfalls to Avoid

• Failing to adjust dosing in patients with renal impairment (creatinine clearance <50 mL/min) 1
• Administering levofloxacin concurrently with divalent or trivalent cations, which can significantly reduce absorption 4
• Inadequate hydration, which may increase the risk of crystalluria 1
• Using levofloxacin as first-line therapy for uncomplicated infections when narrower-spectrum antibiotics would be appropriate 2