What is the dosage of Levaquin (levofloxacin) for a sinus infection?

Levaquin (Levofloxacin) Dosing for Sinus Infection

For acute bacterial sinusitis in adults, levofloxacin is dosed at either 500 mg orally once daily for 10-14 days or 750 mg orally once daily for 5 days. 1

FDA-Approved Dosing Regimens

Levofloxacin has two approved treatment regimens for acute bacterial sinusitis 1:

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

Both regimens demonstrate equivalent clinical efficacy, with success rates of 91.4% for the 750 mg 5-day regimen and 88.6% for the 500 mg 10-day regimen 1, 2

Position in Treatment Algorithm

Levofloxacin should be reserved as second-line therapy, not first-line treatment. 3, 4

First-Line Treatment Should Be:

• Amoxicillin (1.5-4 g/day) or amoxicillin-clavulanate (1.75-4 g/250 mg per day) for most patients 3, 4, 5
• Standard-dose amoxicillin (500 mg twice daily) for mild disease without recent antibiotic use 4, 5
• High-dose amoxicillin (875 mg twice daily or 4 g/day) for moderate disease or recent antibiotic exposure 3, 4

When to Use Levofloxacin:

Fluoroquinolones like levofloxacin are specifically recommended for 3, 4:

• Frontal, ethmoidal, or sphenoidal sinusitis (complicated sinusitis with higher risk of complications) 3, 4
• Treatment failure after 72 hours of first-line therapy 3, 4
• Moderate to severe disease in patients with recent antimicrobial use (past 4-6 weeks) 3
• True penicillin allergy (Type I hypersensitivity) where cephalosporins cannot be used 3, 4

Clinical Efficacy Data

The respiratory fluoroquinolones (including levofloxacin) demonstrate predicted clinical efficacy of 90-92% for acute bacterial sinusitis 3

Microbiologic eradication rates for common pathogens are 6, 7:

• Streptococcus pneumoniae: 100% 6
• Haemophilus influenzae: 95-97% 6, 2
• Moraxella catarrhalis: 93-100% 6, 2

Important Clinical Caveats

Do not use levofloxacin as routine first-line therapy. The guidelines consistently emphasize reserving fluoroquinolones for specific situations to prevent resistance development 3, 4

The 750 mg 5-day regimen is non-inferior to the 500 mg 10-day regimen and may improve adherence, though both are FDA-approved options 1, 2

Levofloxacin provides excellent coverage against resistant S. pneumoniae including multi-drug resistant strains (MDRSP), making it particularly valuable for treatment failures 3, 1

Reassess patients at 72 hours if using any antibiotic therapy; lack of improvement warrants switching to broader coverage or obtaining cultures 3, 4