Levofloxacin

Levofloxacin is a synthetic broad-spectrum antibacterial agent from the fluoroquinolone class. It selectively inhibits bacterial DNA gyrase (topoisomerase II) and topoisomerase IV, which are essential enzymes for bacterial DNA replication, transcription, repair, and recombination. This inhibition leads to breaks in bacterial DNA, ultimately resulting in bacterial cell death.

Adult

Oral/IV: 250 mg to 750 mg once daily, depending on the indication. For acute bacterial sinusitis, 500 mg once daily for 10-14 days or 750 mg once daily for 5 days. For community-acquired pneumonia, 500 mg once daily for 7-14 days or 750 mg once daily for 5 days. For uncomplicated UTI, 250 mg once daily for 3 days. For complicated UTI/Pyelonephritis, 250 mg once daily for 7-10 days.

Pediatric

Not generally recommended due to risk of arthropathy. For specific severe infections like anthrax or plague: Age 6 months to <5 years: 8 mg/kg IV/oral every 12 hours (max 250 mg/dose). Age 5 years and older: 10 mg/kg IV/oral once daily (max 750 mg/dose).

Renal adjustment

CrCl 50-80 mL/min: No adjustment. CrCl 20-49 mL/min: Initial 250-750 mg, then 125-250 mg every 24 hours (depending on initial dose). CrCl 10-19 mL/min: Initial 250-750 mg, then 125 mg every 24 hours (depending on initial dose). Hemodialysis/CAPD: Initial 250-750 mg, then 125 mg every 48 hours (depending on initial dose).

Hepatic adjustment

No specific dose adjustment is recommended for hepatic impairment as levofloxacin is minimally metabolized in the liver.

Geriatric

Dose adjustment is primarily based on renal function. Elderly patients may be at increased risk for tendinopathy, QT prolongation, and central nervous system effects; use with caution.

Max dose

Generally 750 mg once daily, although higher doses (e.g., 1000 mg/day) may be used for specific, severe indications under strict supervision.

• Hypersensitivity to levofloxacin or other fluoroquinolones
• History of tendinitis or tendon rupture associated with fluoroquinolone use
• Myasthenia gravis (potential for exacerbation)
• Concurrent use with drugs known to prolong the QT interval in patients with known QT prolongation, uncorrected hypokalemia, or significant bradycardia
• Epilepsy or other seizure disorders (relative contraindication)
• Children and adolescents before epiphyseal closure (relative, due to risk of cartilage damage, unless benefits outweigh risks for severe infections)