Typical Dosage of Levofloxacin for Bacterial Infections
The typical dosage of levofloxacin for treating bacterial infections is 250 mg, 500 mg, or 750 mg administered orally once daily, with the specific dose and duration determined by the type and severity of infection. 1
Standard Dosing Regimens by Infection Type
Respiratory Infections
- For community-acquired pneumonia (CAP), a high-dose, short-course regimen of 750 mg once daily for 5 days is recommended, which is equally effective as longer treatment courses 2
- For acute exacerbations of chronic bronchitis, 500 mg once daily for 7 days is the standard dosage 2, 3
- For acute bacterial sinusitis, 750 mg once daily for 5 days is recommended 3
- For severe CAP requiring ICU care, 750 mg IV/PO once daily is recommended, often in combination with other antibiotics 2, 3
- For Legionella species infections, 750 mg IV/PO once daily is the preferred treatment 4
Urinary Tract Infections
- For complicated urinary tract infections, 750 mg once daily for 5 days is the recommended dosage 5
- For acute pyelonephritis, 750 mg once daily for 5 days is effective 5, 6
- For uncomplicated UTIs, 250 mg once daily for 3 days has shown high efficacy 6
Other Infections
- For complicated skin and skin structure infections, 750 mg IV/PO once daily for 7-14 days is recommended 7, 8
- For chronic bacterial prostatitis, 500 mg once daily for 28 days has shown similar efficacy to ciprofloxacin 7, 6
Special Considerations
Renal Dosage Adjustments
- No adjustment is necessary for patients with creatinine clearance ≥50 mL/min 1
- For patients with creatinine clearance <50 mL/min, dosage adjustment is required to prevent drug accumulation 1
- In severe renal impairment, 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 and potential crystalluria 1
Pathogen-Specific Considerations
- For Pseudomonas aeruginosa infections, levofloxacin should be combined with antipseudomonal beta-lactams for optimal efficacy 4, 2
- For Streptococcus pneumoniae infections, levofloxacin is effective against both penicillin-susceptible and penicillin-resistant strains 7
- For Mycoplasma pneumoniae, levofloxacin 750 mg PO/IV once daily for 7-14 days is recommended, though macrolides are preferred 4
- For Chlamydophila pneumoniae, 500-750 mg PO/IV once daily for 7-10 days is recommended 4
Clinical Pearls
- The high-dose (750 mg), short-course (5 days) regimen maximizes concentration-dependent bactericidal activity and may reduce the potential for resistance development 5
- Treatment duration should generally not exceed 8 days in responding patients 2, 3
- Previous exposure to fluoroquinolones in the recent past may preclude the use of levofloxacin due to potential resistance development 2, 3
- Levofloxacin has good tissue penetration, allowing for effective treatment of various infection sites 9
Pediatric Considerations
- The long-term use of levofloxacin in children and adolescents has not been approved due to concerns about effects on bone and cartilage growth 4
- However, most experts agree that levofloxacin should be considered for children with tuberculosis caused by organisms resistant to both isoniazid and rifampin 4, 3
- For children 6 months to 5 years of age, the dose is 16-20 mg/kg/day divided every 12 hours 4
- For children 5 years and older, 10 mg/kg/day once daily is recommended (maximum dose: 750 mg) 4