Levofloxacin Dosing for Various Infections
Levofloxacin dosing varies by infection type and severity, with standard adult doses ranging from 250 mg to 750 mg once daily, administered orally or intravenously for durations of 3 to 14 days depending on the clinical indication. 1
Standard Adult Dosing by Infection Type
Respiratory Tract Infections
Community-Acquired Pneumonia (CAP):
- Standard regimen: 500 mg once daily for 7-14 days 2, 1
- High-dose short-course: 750 mg once daily for 5 days is equally effective and FDA-approved 3, 4
- For severe CAP requiring ICU care, consider 750 mg IV once daily or 500 mg IV twice daily, often combined with other antibiotics 3
Acute Bacterial Sinusitis:
Acute Exacerbations of Chronic Bronchitis:
Nosocomial Pneumonia:
Urinary Tract Infections
Uncomplicated UTIs:
Complicated UTIs and Acute Pyelonephritis:
- Standard: 250 mg once daily for 7-10 days 1, 6
- High-dose short-course: 750 mg once daily for 5 days 4, 1
- Use only where fluoroquinolone resistance in community uropathogens does not exceed 10% 2
Chronic Bacterial Prostatitis:
- 500 mg once daily for 28 days 5
Skin and Soft Tissue Infections
Uncomplicated Skin Infections:
Complicated Skin and Skin Structure Infections:
Drug-Resistant Tuberculosis
When first-line agents cannot be used:
- 500-1,000 mg daily for adults 7, 2
- Levofloxacin is the preferred fluoroquinolone for MDR-TB due to established long-term safety profile 7
- Should not be used as first-line agent for drug-susceptible TB 7
Pediatric Dosing
General principle: Levofloxacin is generally not recommended for routine pediatric use due to concerns about effects on bone and cartilage growth 7
When benefits outweigh risks (e.g., MDR-TB, resistant infections):
- Children ≥5 years: 10 mg/kg once daily (maximum 750 mg) 7, 2
- Children 6 months to <5 years: 10 mg/kg divided every 12 hours (maximum 750 mg/day) due to faster drug clearance 7, 2
Specific indications where fluoroquinolones may be considered: 7
- Complicated UTIs with resistant organisms
- Acute otitis media or sinusitis when other options have failed
- Pneumonia caused by resistant S. pneumoniae
- Tuberculosis resistant to isoniazid and rifampin 3
Renal Dose Adjustments
Critical consideration: Levofloxacin is 80% renally cleared and requires dose adjustment for creatinine clearance <50 mL/min 7, 1
Dosing adjustments: 1
- CrCl 20-49 mL/min:
- For 750 mg dose: Give 750 mg initial dose, then 750 mg every 48 hours
- For 500 mg dose: Give 500 mg initial dose, then 250 mg every 24 hours
- CrCl 10-19 mL/min:
- For 750 mg dose: Give 750 mg initial dose, then 500 mg every 48 hours
- For 500 mg dose: Give 500 mg initial dose, then 250 mg every 48 hours
- Hemodialysis: No supplemental doses needed after dialysis 7
Administration Considerations
Drug interactions requiring timing adjustments:
- Administer at least 2 hours before or 2 hours after antacids containing magnesium or aluminum, sucralfate, iron, multivitamins with zinc, or didanosine 1, 7
Food and hydration:
IV to oral transition:
Special Population Warnings
Pregnancy:
Hepatic disease:
- No dose adjustment required; presumed safe but use with caution 7
Important Clinical Caveats
Resistance considerations:
- Previous fluoroquinolone exposure may preclude use due to resistance 3
- Current S. pneumoniae resistance to levofloxacin remains <1% in the US 5
- For Pseudomonas aeruginosa infections, combine with antipseudomonal beta-lactams 3, 8
Monitoring: