Levofloxacin Dosage

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Usual Adult Dose for Nosocomial Pneumonia

750 mg orally or IV every 24 hours for 7 to 14 days

Initial empiric treatment with broad-spectrum coverage according to the hospital's and/or ICU's antibiogram is recommended if multidrug-resistant organisms are suspected.

Duration: If the causative organism is not Pseudomonas aeruginosa, the duration of treatment should be as short as clinically possible (e.g., as little as 7 days) to reduce the risk of superinfections with resistant organisms.

Usual Adult Dose for Pneumonia

Community-acquired pneumonia:
Due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae (including multi-drug resistant S pneumoniae [MDRSP]), Haemophilus influenzae, H parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydophila pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae: 500 mg orally or IV every 24 hours for 7 to 14 days

Due to S pneumoniae (excluding MDRSP), H influenzae, H parainfluenzae, M pneumoniae, or C pneumoniae: 750 mg orally or IV every 24 hours for 5 days

Usual Adult Dose for Sinusitis

Acute bacterial sinusitis: 500 mg orally or IV every 24 hours for 10 to 14 days or 750 mg orally or IV every 24 hours for 5 days

Usual Adult Dose for Bronchitis

Acute bacterial exacerbation of chronic bronchitis: 500 mg orally or IV once a day for 7 days

Usual Adult Dose for Skin or Soft Tissue Infection

Uncomplicated: 500 mg orally or IV once a day for 7 to 10 days
Complicated: 750 mg orally or IV once a day for 7 to 14 days

Usual Adult Dose for Prostatitis

Chronic bacterial prostatitis: 500 mg orally or IV every 24 hours for 28 days

Usual Adult Dose for Urinary Tract Infection

Complicated:
Due to Enterococcus faecalis, Enterobacter cloacae, E coli, K pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa: 250 mg orally or IV once a day for 10 days
Due to E coli, K pneumoniae, or P mirabilis: 750 mg orally or IV once a day for 5 days

Uncomplicated: 250 mg orally or IV once a day for 3 days

Usual Adult Dose for Pyelonephritis

Acute:
Due to Escherichia coli: 250 mg orally or IV once a day for 10 days
Due to E coli (including cases with concurrent bacteremia): 750 mg orally or IV once a day for 5 days

Usual Adult Dose for Cystitis

250 mg orally or IV once a day for 3 days

Usual Adult Dose for Anthrax Prophylaxis

Prophylaxis postexposure to inhalational Bacillus anthracis: 500 mg orally or IV once a day for 60 days after exposure

Usual Adult Dose for Plague

For treatment of plague (including pneumonic and septicemic plague) and prophylaxis for plague: 500 mg orally or IV once a day for 10 to 14 days

Drug administration should begin as soon as possible after suspected or confirmed exposure to Yersinia pestis. Higher doses (750 mg orally or IV once a day) can be used for treatment of plague if clinically indicated.

Usual Adult Dose for Plague Prophylaxis

For treatment of plague (including pneumonic and septicemic plague) and prophylaxis for plague: 500 mg orally or IV once a day for 10 to 14 days

Drug administration should begin as soon as possible after suspected or confirmed exposure to Yersinia pestis. Higher doses (750 mg orally or IV once a day) can be used for treatment of plague if clinically indicated.

Usual Adult Dose for Inhalation Bacillus anthracis

(Not approved by FDA)

Mass casualty treatment: 500 mg orally or IV once a day for 60 days

The Working Group on Civilian Biodefense has suggested that, based on in vitro studies, levofloxacin could be used for treatment of inhalational anthrax if ciprofloxacin and doxycycline are not available. One or two additional antibiotics with activity against the causative organism (e.g., rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, imipenem, clindamycin, or clarithromycin) should be added.

Usual Adult Dose for Tuberculosis - Active

(Not approved by FDA)

500 to 1000 mg orally or IV once a day

This regimen has been recommended by the Centers for Disease Control and Prevention (CDC), the Infectious Diseases Society of America, and American Thoracic Society.

May be given in combination with at least 3 other active drugs for treatment of multi-drug resistant TB, or when the patient is intolerant of first-line agents. AFB smear and culture should be monitored monthly.

Duration: Treatment for TB should generally continue for 18 to 24 months, or for 12 to 18 months after culture results are negative.

Usual Adult Dose for Nongonococcal Urethritis

(Not approved by FDA)

CDC recommendations: 500 mg orally once a day for 7 days

Levofloxacin therapy is recommended as an alternative regimen. Single-dose azithromycin is a preferred regimen.

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Chlamydia Infection

(Not approved by FDA)

CDC recommendations: 500 mg orally once a day for 7 days

Levofloxacin therapy is recommended as an alternative regimen. Single-dose azithromycin is a preferred regimen.

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Pelvic Inflammatory Disease

(Not approved by FDA)

CDC recommendations:
Mild to moderately severe acute PID: 500 mg orally once a day for 14 days

Due to high rates of resistance, the CDC does not recommend fluoroquinolones for treatment of gonococcal infections in the United States. As a result, regimens that include a quinolone are not recommended for the treatment of PID. If parenteral cephalosporin therapy is not possible, oral levofloxacin (with or without oral metronidazole) can be considered if community prevalence and individual risk for gonorrhea are low. Prior to therapy, diagnostic tests for gonorrhea must be performed. If test results are positive for quinolone-resistant Neisseria gonorrhoeae and cephalosporin therapy is not possible, single-dose azithromycin should be added to this quinolone-based PID regimen.

If patients do not respond to oral therapy within 72 hours, they should be reevaluated and parenteral therapy should be initiated.

Usual Adult Dose for Epididymitis - Sexually Transmitted

(Not approved by FDA)

CDC recommendations: 500 mg orally once a day for 10 days

The patient's sexual partner(s) should also be evaluated/treated.

All patients should receive ceftriaxone plus doxycycline for initial (empiric) treatment. Additional therapy can include levofloxacin if testing determines acute epididymitis is not caused by gonorrhea or if the infection is most likely caused by enteric organisms.

Due to high rates of resistance, the CDC does not recommend fluoroquinolones for treatment of gonococcal infections in the United States. Ceftriaxone is the first-line agent recommended for the treatment of gonococcal infections in the United States. Antimicrobial susceptibility patterns should be monitored.

Usual Pediatric Dose for Anthrax Prophylaxis

Prophylaxis postexposure to inhalational B anthracis:
6 months or older:
Less than 50 kg: 8 mg/kg orally or IV every 12 hours for 60 days; not to exceed 250 mg per dose
50 kg or more: 500 mg orally or IV every 24 hours for 60 days

Usual Pediatric Dose for Plague

For treatment of plague (including pneumonic and septicemic plague) and prophylaxis for plague:
6 months or older:
Less than 50 kg: 8 mg/kg orally or IV every 12 hours for 10 to 14 days; not to exceed 250 mg per dose
50 kg or more: 500 mg orally or IV every 24 hours for 10 to 14 days

Drug administration should begin as soon as possible after suspected or confirmed exposure to Yersinia pestis.

Usual Pediatric Dose for Plague Prophylaxis

For treatment of plague (including pneumonic and septicemic plague) and prophylaxis for plague:
6 months or older:
Less than 50 kg: 8 mg/kg orally or IV every 12 hours for 10 to 14 days; not to exceed 250 mg per dose
50 kg or more: 500 mg orally or IV every 24 hours for 10 to 14 days

Drug administration should begin as soon as possible after suspected or confirmed exposure to Yersinia pestis.

Renal Dose Adjustments

Adults:
When dosage in normal renal function is 750 mg every 24 hours:
CrCl 20 to 49 mL/min: 750 mg orally or IV every 48 hours
CrCl 10 to 19 mL/min: 750 mg once, followed by 500 mg orally or IV every 48 hours

When dosage in normal renal function is 500 mg every 24 hours:
CrCl 20 to 49 mL/min: 500 mg once, followed by 250 mg orally or IV every 24 hours
CrCl 10 to 19 mL/min: 500 mg once, followed by 250 mg orally or IV every 48 hours

When dosage in normal renal function is 250 mg every 24 hours:
CrCl 20 to 49 mL/min: No adjustment recommended.
CrCl 10 to 19 mL/min: 250 mg orally or IV every 48 hours; however, if treating uncomplicated urinary tract infection, no adjustment is required

Tuberculosis:
CrCl less than 50 mL/min: 750 to 1000 mg orally or IV 3 times a week

Pediatrics: Data not available

Liver Dose Adjustments

Data not available

Precautions

Consult WARNINGS section for dosing related precautions.

Dialysis

Hemodialysis or chronic ambulatory peritoneal dialysis:
Adults:
When dosage in normal renal function is 750 mg every 24 hours: 750 mg once, followed by 500 mg orally or IV every 48 hours
When dosage in normal renal function is 500 mg every 24 hours: 500 mg once, followed by 250 mg orally or IV every 48 hours
When dosage in normal renal function is 250 mg every 24 hours: Data not available

Tuberculosis: 750 to 1000 mg orally or IV 3 times a week; CAPD patients should be monitored to ensure doses are adequate

Continuous renal replacement therapy: Clearance may be significantly increased. Doses of 250 mg every 24 hours have been recommended. Monitor closely to ensure doses are adequate.

Pediatrics: Data not available

Other Comments

The manufacturer's Medication Guide should be dispensed with each new and refill prescription.

Levofloxacin tablets may be taken without regard to meals. Levofloxacin oral solution should be taken 1 hour before or 2 hours after eating. Both the tablets and the oral solution should be administered at the same time each day. Patients should be advised to drink plenty of fluids.

Oral doses should be administered at least 2 hours before or 2 hours after iron-, zinc-, aluminum-, or magnesium-containing compounds (e.g., antacids, sucralfate, mineral supplements, buffered didanosine).

The 250 mg and 500 mg IV doses should be infused over at least 60 minutes and 750 mg doses should be infused over at least 90 minutes.

Sequential therapy (IV to oral) may be started at the physician's discretion.

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