Levofloxacin 750mg Dosing in Hemodialysis Patients
For a chronic kidney disease patient on hemodialysis, levofloxacin 750mg should be administered three times per week immediately after each hemodialysis session, not daily. 1, 2
Dosing Regimen
- Administer 750-1000mg three times weekly (not daily) after each hemodialysis session 1, 2
- The dose magnitude should remain 750mg or higher—never reduce the individual dose below this threshold 2
- Adjust frequency (not dose size) to prevent drug accumulation in renal impairment 2
Critical Timing: Always Post-Dialysis
- Give levofloxacin immediately after hemodialysis, never before 1, 2
- Pre-dialysis administration results in premature drug removal during the dialysis session, leading to therapeutic failure 2
- Post-dialysis timing also facilitates directly observed therapy and ensures adequate drug exposure 1, 2
Pharmacologic Rationale
- Daily dosing is contraindicated in hemodialysis patients as it causes drug accumulation and increases neurotoxicity risk 2
- Levofloxacin exhibits concentration-dependent bactericidal activity, requiring adequate peak concentrations rather than sustained levels 2
- The FDA label confirms dose adjustment is mandatory when creatinine clearance <50 mL/min to avoid accumulation 3
- Hemodialysis patients have essentially zero creatinine clearance, necessitating the three-times-weekly schedule 1, 2
Monitoring Recommendations
- Consider serum drug concentration monitoring to ensure adequate absorption without excessive accumulation 1, 2
- Monitor specifically for neurotoxicity, particularly in elderly patients, as this is a well-recognized complication in renal impairment 2
- Evaluate renal function before initiating treatment and periodically during therapy 1
Common Pitfalls to Avoid
- Never use daily dosing in hemodialysis patients—this leads to dangerous drug accumulation 2
- Never reduce the individual dose to compensate for renal impairment—extend the interval instead 2
- Never administer before hemodialysis—this results in premature drug removal and therapeutic failure 2
- Do not assume "normal" serum creatinine indicates adequate renal function, as muscle mass decline can mask severe renal impairment 1
Route of Administration
- Both IV and oral levofloxacin achieve equivalent plasma exposures and can be used interchangeably at the same dose (mg per mg) 2
- Oral administration can be given without regard to food 3
- Maintain adequate hydration to prevent crystalluria 3