What is the oral dose of Levofloxacin (levofloxacin) for pneumonia?

From the Guidelines

For community-acquired pneumonia in adults, the recommended oral dose of levofloxacin is 500 mg once daily, as indicated in the guidelines for hospital-treated, non-severe pneumonia 1. This dose is recommended as an alternative initial empirical antibiotic treatment regimen for pneumonic lower respiratory tract infections complicating influenza managed in hospital. The guidelines suggest that levofloxacin, with enhanced pneumococcal activity, can be used as an alternative choice in certain circumstances, such as when patients are intolerant of penicillins or when local microbiological surveillance suggests it is a better choice. It is essential to note that the more recent guidelines from the American Thoracic Society and Infectious Diseases Society of America 1 recommend standard antibacterial treatment, including levofloxacin, for adults with clinical and radiographic evidence of community-acquired pneumonia who test positive for influenza. However, the specific dose of 500 mg once daily is supported by the earlier guidelines 1, which provide a clear recommendation for the treatment of pneumonia in the context of influenza. Key points to consider when prescribing levofloxacin include:

• The dose should be adjusted for patients with renal impairment
• Patients should maintain adequate hydration during treatment
• Levofloxacin is effective against common pneumonia pathogens, including Streptococcus pneumoniae and Haemophilus influenzae
• Patients should complete the full course even if symptoms improve, and avoid taking antacids, iron, or multivitamins within 2 hours of taking levofloxacin.

From the FDA Drug Label

Clinical success (cure plus improvement) with levofloxacin at 5 to 7 days posttherapy, the primary efficacy variable in this study, was superior (95%) to the control group (83%). The clinical success rate in patients with atypical pneumonia due to Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila were 96%, 96%, and 70%, respectively. Levofloxacin was effective for the treatment of community-acquired pneumonia caused by multi-drug resistant Streptococcus pneumoniae (MDRSP). Of 40 microbiologically evaluable patients with MDRSP isolates, 38 patients (95%) achieved clinical and bacteriologic success at post-therapy. Clinical success rates (cure plus improvement) in the clinically evaluable population were 90.9% in the levofloxacin 750 mg group and 91.1% in the levofloxacin 500 mg group.

The recommended oral dose of levofloxacin for pneumonia is:

• 500 mg once daily for 7 to 14 days
• 750 mg once daily for 5 days The clinical success rates for levofloxacin in the treatment of pneumonia are:
• 95% for community-acquired pneumonia
• 90.9% for the 750 mg dose
• 91.1% for the 500 mg dose
• 95% for multi-drug resistant Streptococcus pneumoniae 2

From the Research

Levofloxacin Oral Dose for Pneumonia

• The recommended oral dose of levofloxacin for community-acquired pneumonia (CAP) is 750 mg once daily for 5 days 3, 4, 5.
• This high-dose, short-course regimen is approved for use in the US and has been shown to be effective in treating CAP, including cases caused by atypical pathogens 5.
• The efficacy and tolerability of levofloxacin 500 mg once daily for 10 days in patients with CAP are also well established 3, 4.
• Levofloxacin can be used as monotherapy in patients with CAP, but combination therapy with an anti-pseudomonal beta-lactam (or aminoglycoside) should be considered if Pseudomonas aeruginosa is the causative pathogen 4, 6.
• High-dose, short-course therapy regimens may offer improved treatment due to higher drug concentrations, increased adherence, and the potential to reduce the development of resistance 3, 4, 6, 7.

Tolerability and Safety

• Levofloxacin is generally well tolerated and has a good safety profile 3, 4, 6.
• The most common adverse effects of levofloxacin are gastrointestinal and include nausea, diarrhea, and vomiting 3.
• Levofloxacin has good tissue penetration and adequate concentrations can be maintained at the site of infection 3, 4, 6.

Comparison with Other Treatments

• Levofloxacin has been shown to be noninferior to ciprofloxacin in patients with complicated urinary tract infections or acute pyelonephritis 3.
• Levofloxacin monotherapy is as efficacious as combination ceftriaxone-erythromycin therapy in the treatment of patients hospitalized with CAP 7.
• Short-course therapy with levofloxacin, azithromycin, or telithromycin in patients with CAP was effective, safe, and tolerable and may control the rate of resistance 7.