Recommended Dose of Levofloxacin for Tuberculosis Treatment
The recommended dose of levofloxacin for tuberculosis treatment in adults is 750-1,000 mg once daily. 1
Adult Dosing
- For multidrug-resistant tuberculosis (MDR-TB), levofloxacin should be administered at 750-1,000 mg daily as part of a multidrug regimen 1
- Levofloxacin is available in tablet formulations (250 mg, 500 mg, 750 mg) and as an aqueous solution (500 mg) for intravenous administration 1, 2
- For patients with renal insufficiency (creatinine clearance <50 mL/min), the dose should be adjusted to 750-1,000 mg three times weekly instead of daily 1, 2
- Higher doses up to 1,000 mg/day have shown good tolerability with adequate exposure, while doses >1,000 mg/day resulted in increased adverse events without faster sputum culture conversion 3
Pediatric Dosing
- For children with MDR-TB, the recommended dose is 15-20 mg/kg/day once daily 1
- Recent pharmacokinetic studies suggest that higher doses may be required in children to achieve adult-equivalent exposures: from 18 mg/kg/day for younger children to 40 mg/kg/day for older children 1, 4
- Long-term use of fluoroquinolones in children has traditionally been limited due to concerns about effects on bone and cartilage growth, but most experts agree the drug should be considered for children with MDR-TB 1, 5
Clinical Considerations
- Levofloxacin is preferred over other fluoroquinolones for treating drug-resistant TB due to its established safety profile with long-term use 1
- Absorption is significantly decreased when administered with antacids or medications containing divalent cations; levofloxacin should not be given within 2 hours of such medications 1, 2
- The drug is primarily cleared by the kidneys (80%), requiring dose adjustment in renal insufficiency 1, 2
- Levofloxacin should be avoided during pregnancy due to potential teratogenic effects 1, 5
Efficacy Considerations
- Levofloxacin (750 mg/day) has shown similar efficacy to moxifloxacin (400 mg/day) in terms of sputum culture conversion at 3 months of treatment for MDR-TB 6
- For Mycobacterium tuberculosis isolates with higher minimum inhibitory concentrations (MIC ≥1 mg/L), doses up to 1,500 mg may be required to achieve optimal exposure 7, 8
- When selecting the dose, consider that the area under the concentration-time curve to MIC ratio (AUC/MIC) of approximately 146-160 is associated with maximal microbial kill 7
Adverse Effects
- Common adverse effects include gastrointestinal disturbances (nausea, bloating) in 0.5-1.8% of patients 1
- Neurological effects (dizziness, insomnia, tremulousness, headache) occur in approximately 0.5% of patients 1
- Cutaneous reactions (rash, pruritus, photosensitivity) occur in 0.2-0.4% of patients 1
- Higher doses (>1,000 mg/day) are associated with increased frequency of adverse events 3