Maximum Dose of Intravenous Levofloxacin
The maximum recommended dose of intravenous levofloxacin is 750 mg once daily for adults, which has been validated for severe infections including nosocomial pneumonia, complicated skin and skin structure infections, and community-acquired pneumonia. 1, 2
Standard Maximum Dosing for Adults
- 750 mg IV once daily is the established maximum dose for most severe bacterial infections in adults with normal renal function 1, 3
- This dose has been specifically studied and approved for complicated infections requiring intensive therapy 4, 5
- For certain indications like multidrug-resistant tuberculosis, doses up to 1,000 mg once daily have been used safely, though this represents the upper limit of dosing 2, 3
Clinical Context for Maximum Dosing
The 750 mg daily dose is recommended for:
- Nosocomial pneumonia: 750 mg IV once daily for 7-14 days 1
- Complicated skin and skin structure infections: 750 mg IV once daily for 7-14 days 1, 4
- Severe community-acquired pneumonia: 750 mg IV once daily 1, 3
- Drug-resistant tuberculosis: 750-1,000 mg once daily (maximum 1,000 mg) 2, 3
Pediatric Maximum Dosing
- For children ≥5 years: maximum 750 mg once daily (calculated as 10 mg/kg, not to exceed 750 mg) 2, 6
- For children 6 months to <5 years: maximum 750 mg/day total (given as 10 mg/kg divided every 12 hours due to faster clearance) 1, 2
Critical Dosing Adjustments
Renal impairment requires mandatory dose reduction:
- For creatinine clearance <50 mL/min: reduce to 750 mg three times weekly (not daily) 2, 3
- Levofloxacin is 80% renally cleared, making dose adjustment essential to prevent accumulation 2
- No supplemental doses needed after hemodialysis 2
Hepatic impairment:
- No dose adjustment required, as hepatic metabolism is minimal 2
Important Safety Considerations
- Never exceed 1,000 mg daily, even in severe infections, as higher doses have not been studied and may increase toxicity risk 2, 3
- The 750 mg dose achieves significantly higher peak concentrations (Cmax) and AUC values compared to standard 500 mg dosing, providing enhanced bacterial killing for difficult-to-treat infections 5
- Administration should be via 60-minute IV infusion to minimize infusion-related reactions 7, 8
Common Pitfall to Avoid
Do not administer levofloxacin within 2 hours of antacids or medications containing divalent cations (calcium, magnesium, aluminum, iron), as these markedly decrease fluoroquinolone absorption even with IV administration due to chelation effects 2