What is the recommended dose of Levofloxacin (Levofloxacin) for a chest infection?

Levofloxacin Dosing for Chest Infection (Community-Acquired Pneumonia)

For community-acquired pneumonia (chest infection), use levofloxacin 750 mg once daily for 5 days, which provides equivalent efficacy to the traditional 500 mg for 10 days while maximizing bacterial killing and improving compliance. 1, 2

Standard Dosing Regimen

• Levofloxacin 750 mg IV or oral once daily for 5 days is the preferred regimen for outpatients with comorbidities and hospitalized patients with moderate CAP without Pseudomonas risk factors 1, 3
• The 750 mg dose can be given intravenously or orally, as oral levofloxacin is bioequivalent to IV formulation, allowing seamless transition between routes 4, 5
• Treatment duration should not exceed 8 days in responding patients 1, 2

Alternative Dosing

• Levofloxacin 500 mg once daily for 7-10 days remains an acceptable alternative, though the higher dose shorter course is now preferred 1, 3
• The 750 mg for 5 days regimen was shown to be non-inferior to 500 mg for 10 days in clinical trials, with clinical success rates of 90.9% vs 91.1% respectively 3

When Levofloxacin Works as Monotherapy

• Levofloxacin can be used as monotherapy for CAP, which is a significant advantage over beta-lactams that require macrolide combination 1
• It provides comprehensive coverage for Streptococcus pneumoniae (including multi-drug resistant strains), Haemophilus influenzae, Moraxella catarrhalis, and atypical pathogens (Legionella, Mycoplasma, Chlamydophila) 1, 2, 6

Critical Exceptions Requiring Combination Therapy

• If Pseudomonas aeruginosa is suspected or documented, levofloxacin 750 mg must be combined with an antipseudomonal beta-lactam (piperacillin-tazobactam, ceftazidime, or cefepime), as levofloxacin monotherapy is inadequate 1, 2, 7
• If MRSA is suspected, add vancomycin or linezolid, as levofloxacin has no MRSA coverage 1, 2
• For severe CAP requiring ICU admission, use levofloxacin 750 mg daily plus a non-antipseudomonal cephalosporin (ceftriaxone or cefotaxime) 1

Contraindications to Levofloxacin Use

• Do not use levofloxacin if the patient had fluoroquinolone exposure within the past 90 days due to high resistance risk 1
• Avoid in patients with known fluoroquinolone hypersensitivity or history of tendon disorders 8

Monitoring Clinical Response

• Assess response within 48-72 hours by monitoring temperature normalization, respiratory rate, oxygen saturation, and ability to eat 1, 2
• Switch from IV to oral can occur once the patient is clinically stable (afebrile for 24 hours, hemodynamically stable, able to take oral medications) 1, 7
• If no improvement after 48-72 hours, obtain repeat chest radiograph, inflammatory markers, and additional cultures 1

Renal Dosing Adjustments

• In severe renal impairment or dialysis, dosage adjustment is required to avoid drug accumulation—consult nephrology or use standard renal dosing guidelines 1

Common Pitfalls to Avoid

• Do not combine levofloxacin with amoxicillin or other beta-lactams for routine CAP—there is no evidence supporting this combination and it increases adverse effects without improving outcomes 1
• Do not extend treatment beyond 8 days in responding patients, as this increases resistance selection without added benefit 9, 1
• Do not use levofloxacin as first-line in areas with high fluoroquinolone resistance rates among pneumococci 8