Levofloxacin Dosing Frequency
Yes, levofloxacin is dosed once daily for the vast majority of indications in adults with normal renal function. 1, 2, 3, 4
Standard Once-Daily Dosing Regimens
Levofloxacin is administered once daily across virtually all approved indications:
- Community-acquired pneumonia (non-severe): 500 mg once daily orally or IV 1, 4
- Community-acquired pneumonia (severe): 750 mg once daily orally or IV 2, 4, 5
- Acute bacterial sinusitis: 750 mg once daily for 5 days 3, 5
- Acute exacerbations of chronic bronchitis: 500 mg once daily for 7 days 3
- Complicated urinary tract infections: 500 mg once daily 4, 5
- Complicated skin and skin structure infections: 750 mg once daily for 7-14 days 2, 4
- Drug-resistant tuberculosis: 750-1,000 mg once daily 2, 3
The once-daily dosing is possible because levofloxacin has a long half-life and demonstrates concentration-dependent bactericidal activity, meaning higher peak concentrations optimize bacterial killing. 5, 6
Important Exception: Severe Pneumonia Alternative Regimen
For severe community-acquired pneumonia requiring ICU care, some guidelines suggest 500 mg IV twice daily as an alternative to 750 mg once daily, particularly when used in combination therapy. 1, 3 However, the 750 mg once-daily regimen remains the preferred approach even in severe infections. 2
Critical Pediatric Dosing Exception
Children under 5 years require twice-daily dosing (10 mg/kg divided every 12 hours, maximum 750 mg/day total) due to faster drug clearance in this age group. 1, 2, 3 Children 5 years and older can receive once-daily dosing at 10 mg/kg (maximum 750 mg). 1, 2, 3
Renal Dose Adjustments Maintain Once-Daily Frequency
Even with renal impairment, levofloxacin typically maintains once-daily dosing but at reduced doses or extended intervals:
- Creatinine clearance 50-80 mL/min: 500 mg loading dose, then 250 mg every 24 hours 4
- Creatinine clearance <50 mL/min: 500 mg loading dose, then 250 mg every 48 hours 2, 4
- For tuberculosis with CrCl <50 mL/min: 750-1,000 mg three times weekly (not daily) 2, 3
Because levofloxacin is 80% renally cleared, dose adjustment is essential to prevent drug accumulation and toxicity. 2, 3
Common Pitfall to Avoid
Do not confuse levofloxacin with ciprofloxacin dosing—ciprofloxacin requires twice-daily administration, while levofloxacin is once daily. 1, 7 The once-daily convenience of levofloxacin improves patient compliance and is a key advantage over other fluoroquinolones. 5, 6
The oral formulation is rapidly absorbed and bioequivalent to IV administration, allowing seamless transition between routes without dosage adjustment. 5, 8, 6, 9