levofloxacin

Black Box Warnings .

Adult Dosing .

Dosage forms:  TAB: 250 mg, 500 mg, 750 mg; SOLUTION: 25 mg per mL; INJ: various

pneumonia

[community-acquired]

Dose: 750 mg PO/IV q24h for at least 5 days; Info: may be part of multi-drug regimen; refer to IDSA guidelines; give oral solution 1h before or 2h after meals

[hospital-acquired or ventilator-associated]

Dose: 750 mg IV q24h x7 days; Info: may extend duration based on clinical response; refer to IDSA guidelines

prostatitis, chronic bacterial

[500 mg PO/IV q24h x28 days]

Info: give oral solution 1h before or 2h after meals

UTI

[uncomplicated]

Dose: 250 mg PO/IV q24h x3 days; Info: for patients with no alternative tx options; refer to IDSA guidelines; give oral solution 1h before or 2h after meals

[acute pyelonephritis]

Dose: 750 mg PO/IV q24h x5 days; Alt: 250 mg PO/IV q24h x10 days; Info: may give with ceftriaxone or gentamicin; refer to IDSA guidelines; give oral solution 1h before or 2h after meals

[complicated]

Dose: 750 mg PO/IV q24h x5 days; Alt: 250 mg PO/IV q24h x10 days; Info: give oral solution 1h before or 2h after meals

skin/skin structure infections, bacterial

[uncomplicated]

Dose: 500 mg PO/IV q24h x7-10 days; Info: give oral solution 1h before or 2h after meals

[complicated]

Dose: 750 mg PO/IV q24h x7-14 days; Info: give oral solution 1h before or 2h after meals

anthrax

[systemic]

Dose: 750 mg IV q24h for at least 2wk; Info: not 1st-line agent; may use in pregnant patients; part of multi-drug regimen; switch to PO antibiotic for post-exposure prophylaxis if inhalational exposure; give oral solution 1h before or 2h after meals

[cutaneous]

Dose: 750 mg PO q24h x7-10 days; Info: for non-systemic infection; 1st-line agent; may use in pregnant patients; use extended duration for post-exposure prophylaxis if bioterrorism suspected; give oral solution 1h before or 2h after meals

[post-exposure prophylaxis]

Dose: 750 mg PO q24h x60 days; Info: not 1st-line agent; give in combo with anthrax vaccine; may use in pregnant patients; give oral solution 1h before or 2h after meals; may give x42 days or x14 days after last vaccine dose in immunocompetent patients 18-65 yo if anthrax vaccine regimen completed

plague

[500 mg PO q24h x10-14 days]

Info: for prophylaxis and tx; may incr. to 750 mg PO q24h; give oral solution 1h before or 2h after meals

chronic bronchitis, acute bacterial exacerbation

[500 mg PO/IV q24h x7 days]

Info: for patients with no alternative tx options; give oral solution 1h before or 2h after meals

sinusitis, acute bacterial

[500 mg PO/IV q24h x5-10 days]

Alt: 750 mg PO/IV q24h x5 days; Info: for patients with no alternative tx options; give oral solution 1h before or 2h after meals

infections, chlamydial (off-label)

[500 mg PO q24h x7 days]

Info: not 1st-line agent; give oral solution 1h before or 2h after meals

epididymitis (off-label)

[500 mg PO q24h x10 days]

Info: give with ceftriaxone if chlamydia or gonorrhea suspected; give oral solution 1h before or 2h after meals

PID (off-label)

[500 mg PO/IV q24h x14 days]

Info: for patients with cephalosporin allergy and low gonorrhea risk; give with metronidazole; give oral solution 1h before or 2h after meals

tuberculosis, active (off-label)

[500-1000 mg PO q24h]

Info: not 1st-line agent; part of multi-drug regimen; give oral solution 1h before or 2h after meals

febrile neutropenia, chemo-induced (off-label)

[500-750 mg PO q24h]

Info: for empiric tx in low-risk patients not on fluoroquinolone prophylaxis; give with amoxicillin/clavulanate

infection prophylaxis, surgical (off-label)

[500 mg IV x1]

Start: within 120min preop

H. pylori infection (off-label)

[500 mg PO qd x14 days]

Info: for quinolone-susceptible H. pylori infection only; not 1st-line tx; part of multi-drug regimen; give oral solution 1h before or 2h after meals; search 'H. pylori Treatment' for epocrates H. pylori Treatment Regimens decision tool

endocarditis (off-label)

[750 mg IV q24h]

Info: not 1st-line tx; dose, frequency, duration vary with pathogen susceptibility, infection severity, valve type; refer to AHA guidelines

renal dosing

[tuberculosis]

CrCl <30: 750-1000 mg 3x/wk

HD: 750-1000 mg 3x/wk after dialysis; no supplement; PD: not defined

[all other indications, usual dose 750 mg q24h]

CrCl 20-49: 750 mg q48h; CrCl <20: 750 mg x1, then 500 mg q48h

HD: 750 mg x1, then 500 mg q48h, on dialysis days administer after dialysis; no supplement; PD: 750 mg x1, then 500 mg q48h; no supplement

[all other indications, usual dose 500 mg q24h]

CrCl 20-49: 500 mg x1, then 250 mg q24h; CrCl <20: 500 mg x1, then 250 mg q48h

HD: 500 mg x1, then 250 mg q48h, on dialysis days administer after dialysis; no supplement; PD: 500 mg x1, then 250 mg q48h; no supplement

[all other indications, usual dose 250 mg q24h]

CrCl 10-19: 250 mg q48h; CrCl <10: not defined; Info: no adjustment for uncomplicated UTI

HD/PD: not defined

hepatic dosing

[not defined]

Peds Dosing .

Dosage forms:  TAB: 250 mg, 500 mg, 750 mg; SOLUTION: 25 mg per mL; INJ: various

anthrax, systemic

[1 mo and older, <50 kg]

Dose: 16 mg/kg/day IV divided q12h for at least 2wk; Max: 250 mg/dose; Info: not 1st-line agent; part of multi-drug regimen; switch to PO antibiotic x60 days total if inhalational exposure; give oral solution 1h before or 2h after meals

[1 mo and older, >50 kg]

Dose: 500 mg IV q24h for at least 2wk; Info: not 1st-line agent; part of multi-drug regimen; switch to PO antibiotic x60 days total if inhalational exposure; give oral solution 1h before or 2h after meals

anthrax, cutaneous

[1 mo and older, <50 kg]

Dose: 16 mg/kg/day PO divided q12h x7-10 days; Max: 250 mg/dose; Info: for non-systemic infection; give antibiotic x60 days total if bioterrorism suspected; give oral solution 1h before or 2h after meals

[1 mo and older, >50 kg]

Dose: 500 mg PO q24h x7-10 days; Info: for non-systemic infection; give antibiotic x60 days total if bioterrorism suspected; give oral solution 1h before or 2h after meals

anthrax, post-exposure prophylaxis

[1 mo and older, <50 kg]

Dose: 16 mg/kg/day PO divided q12h x60 days; Max: 250 mg/dose; Info: not 1st-line agent; give oral solution 1h before or 2h after meals

[1 mo and older, >50 kg]

Dose: 500 mg PO q24h x60 days; Info: not 1st-line agent; not 1st-line agent; give oral solution 1h before or 2h after meals

plague

[6 mo and older, <50 kg]

Dose: 16 mg/kg/day PO divided q12h x10-14 days; Max: 250 mg/dose; Info: for prophylaxis and tx; give oral solution 1h before or 2h after meals

[6 mo and older, >50 kg]

Dose: 500 mg PO q24h x10-14 days; Info: for prophylaxis and tx; give oral solution 1h before or 2h after meals

sinusitis, acute bacterial (off-label)

[children]

Dose: 10-20 mg/kg/day PO/IV divided q12-24h x10-14 days; Max: 750 mg/day; Info: give oral solution 1h before or 2h after meals

community-acquired pneumonia, bacterial (off-label)

[IV route, 6 mo-4 yo]

Dose: 16-20 mg/kg/day IV divided q12h x10 days; Max: 750 mg/day; Info: may switch to PO regimen when possible to complete course

[IV route, 5-16 yo]

Dose: 8-10 mg/kg/dose IV q24h x10 days; Max: 750 mg/day; Info: may switch to PO regimen when possible to complete course

[PO route, 6 mo-4 yo]

Dose: 16-20 mg/kg/day PO divided q12h x7-10 days; Max: 750 mg/day; Info: give oral solution 1h before or 2h after meals

[PO route, 5-16 yo]

Dose: 8-10 mg/kg/dose PO q24h x7-10 days; Max: 750 mg/day; Info: give oral solution 1h before or 2h after meals

community-acquired pneumonia, atypical (off-label)

[IV route, 6 mo-4 yo]

Dose: 16-20 mg/kg/day IV divided q12h x10 days; Max: 750 mg/day; Info: may switch to PO regimen when possible to complete course

[IV route, 5-16 yo]

Dose: 8-10 mg/kg/dose IV q24h x10 days; Max: 750 mg/day; Info: may switch to PO regimen when possible to complete course

[PO route, adolescents with skeletal maturity]

Dose: 500 mg PO q24h x7-10 days; Info: give oral solution 1h before or 2h after meals

infections, chlamydial (off-label)

[adolescents]

Dose: 500 mg PO q24h x7 days; Info: not 1st-line agent; give oral solution 1h before or 2h after meals

epididymitis (off-label)

[preadolescents >45 kg and adolescents]

Dose: 500 mg PO q24h x10 days; Info: give with ceftriaxone if chlamydia or gonorrhea suspected; give oral solution 1h before or 2h after meals

PID (off-label)

[adolescents]

Dose: 500 mg PO/IV q24h x14 days; Info: for patients with cephalosporin allergy and low gonorrhea risk; give with metronidazole; give oral solution 1h before or 2h after meals

tuberculosis, active (off-label)

[15-20 mg/kg/dose PO q24h]

Info: not 1st-line agent; part of multi-drug regimen; give oral solution 1h before or 2h after meals

otitis media, acute (off-label)

[6 mo-4 yo]

Dose: 16-20 mg/kg/day PO/IV divided q12h; Info: duration varies with age, infection severity; give oral solution 1h before or 2h after meals

[5 yo and older]

Dose: 10 mg/kg/dose PO/IV q24h; Max: 750 mg/dose; Info: duration varies with age, infection severity; give oral solution 1h before or 2h after meals

infection prophylaxis, surgical (off-label)

[1 yo and older]

Dose: 10 mg/kg/dose IV x1; Start: within 120min preop; Max: 500 mg/dose

renal dosing

[adjust dose frequency]

CrCl 10-29: give usual divided dose q24h; CrCl <10: give usual divided dose q48h

HD: give usual divided dose q48h, on dialysis days administer after dialysis; no supplement; PD: give usual divided dose q48h; no supplement

hepatic dosing

[not defined]