Adult Dosing
Nosocomial Pneumonia
- 750 mg IV q24 hrs for 7-14 days
Community Acquired Pneumonia
- 500 mg IV q24 hrs for 7-14 days or 750 mg IV q24 hrs for 5 days
Acute Bacterial Sinusitis
- 750 mg IV q24 hrs for 5 days or 500 mg IV q24 hrs for 10-14 days
Acute Bacterial Exacerbation of Chronic Bronchitis
- 500 mg IV q24 hrs for 7 days
Skin and Skin Structure Infections
- Complicated: 750 mg IV q24 hrs for 7-14 days
- Uncomplicated: 500 mg IV q24 hrs for 7-10 days
Chronic Bacterial Prostatitis
- 500 mg IV q24 hrs for 28 days
Urinary Tract Infection or Acute Pyelonephritis
- Complicated: 750 mg IV q24 hrs for 5 days or 250 mg IV q24 hrs for 10 days
- Uncomplicated: 250 mg IV q24 hrs for 3 days
Inhalational Anthrax (Post-Exposure)
- 500 mg q24 hrs (first doses to be IV then convert to PO) for 60 days
Bronchiectasis [Not FDA Approved]
Orbital cellulitis [Non-FDA Approved]
Pediatric Dosing
Inhalational Anthrax (Post-Exposure)
Child > 6 mo
- < 50 kg: 8 mg/kg PO or IV q12 hrs for 60 days (Max:250 mg/dose)
- > 50 kg: 500 mg PO or IV q24 hrs for 60 days
Bronchiectasis [Not FDA Approved]
- 6 mos-5 yrs: 20 mg/kg/day divided q12 hrs PO [Max 500 mg/day]
- >5 yrs: 10 mg/kg/day q24 hrs PO/IV [Max 500-750 mg/day]
Orbital cellulitis [Non-FDA Approved]
- 20 mg/kg PO IV [Maximum dose 750 mg]
Notes- Note that dosing is initially to be IV but after several doses, convert to PO
- The safety has not been studied for dosage more than 14 days
[Outline]
Renal Dose Adjustment: Based on CrCl
For usual dose of 750 mg IV q24 hrs
- 20-49 mL/min: 750 mg IV q48 hrs
- 10-19 mL/min: 750 mg IV x 1, then 500 mg IV q48 hrs
- HD/CAPD: 750 mg IV x 1, then 500 mg IV q48 hrs
For usual dose of 500 mg IV q24 hrs
- 20-49 mL/min: 500 mg IV x 1, then 250 mg IV q24 hrs
- 10-19 mL/min: 500 mg IV x 1, then 250 mg IV q48 hrs
- HD/CAPD: 500 mg IV x 1, then 250 mg IV q48 hrs
For usual dose of 250 mg IV q24 hrs
- 10-19 mL/min: 250 mg IV q48 hrs. No dose adjustments required for uncomplicated UTI
- < 10 mL/min: Dose adjustments not defined
- HD/CAPD: Dose adjustments not defined
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined
- Injection should be infused intravenously slowly over a period of not less than 60 or 90 minutes, depending on the dosage
- Rapid or bolus IV infusion of levofloxacin has been associated with hypotension and should be avoided
- Should be administered only by intravenous infusion. It is not for intramuscular, intrathecal, intraperitoneal, or subcutaneous administration
- Levofloxacin may increase risk of tendinitis and tendon rupture in all ages. Discontinue treatment if pain or inflammation in a tendon occurs
- Prolongation of the QT interval and isolated cases of torsade de pointes has been reported. Avoid use in patients with known QT prolongation, those with hypokalemia, and with other drugs that prolong the QT interval
- Serious and occasionally fatal hypersensitivity and/or anaphylactic reactions have been reported after first dose in patients receiving therapy with fluoroquinolones, including levofloxacin
- Severe hepatotoxicity has been reported in patients treated with this drug. The majority of fatal cases occurred in patients 65 years of age or older and most were not associated with hypersensitivity. Discontinue immediately if signs and symptoms of hepatitis occur
- Central nervous system adverse reactions, including convulsions, anxiety, confusion, depression, and insomnia may occur after the first dose. Use with caution in patients with known or suspected CNS disorders
- Clostridium difficile-associated diarrhea (CDAD) has been reported with use the drug and may range in severity from mild diarrhea to fatal colitis
- An increased incidence of musculoskeletal disorders (arthralgia, arthritis, tendonopathy, and gait abnormality) compared to controls has been observed in pediatric patients treated with this drug
- Cases of sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias and weakness have occurred in patients
- Discontinue therapy if the patient experiences symptoms of neuropathy including pain, burning, tingling, numbness, and/or weakness or other alterations of sensation including light touch, pain, temperature, position sense, and vibratory sensation in order to prevent the development of an irreversible condition
- Peripheral neuropathy has been reported, discontinue therapy if symptoms of neuropathy develop
- Avoid excessive sun or UV light
Cautions: Use cautiously in
- Diabetic Patients
- Renal impairment (refer dose adjustment section)
- Known or suspected central nervous system disorder
- Seizure disorder
- Lowered seizure threshold
- Proarrhythmic condition
- Concurrent use of corticosteroids
- Kidney, heart, or lung transplant patients
- Geriatric patients
- Dialysis patients
- Pediatric patients
Pregnancy Category:C
Breastfeeding: Safety unknown; use with caution. Exclusively breastfed infant would receive 1.25 mg daily in breastmilk, if 500 mg/day dose received by mother, which is far below the dose used in children. This information based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 22 July 2010).
