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Levofloxacin - Levaquin ® - Renal dosing

Usual Dosing (Adults)

DOSAGE AND ADMINISTRATION
Dosage in Adult Patients with Normal Renal Function
The usual dose of LEVAQUIN® Injection is 250 mg or 500 mg administered by slow infusion over 60 minutes every 24 hours or 750 mg administered by slow infusion over 90 minutes every 24 hours, as indicated by infection and described in Table 1.

These recommendations apply to patients with creatinine clearance greater than or equal 50 mL/min. For patients with creatinine clearance <50 mL/min, adjustments to the dosing regimen are required.

Table 1: Dosage in Adult Patients with Normal Renal Function (creatinine clearance greater than or equal 50 mL/min)
Type of Infection Dosed Every 24 hours Duration (days)
Nosocomial Pneumonia 750 mg 7–14
Community Acquired Pneumonia‡ 500 mg 7–14
Community Acquired Pneumonia§ 750 mg 5
Acute Bacterial Sinusitis 750 mg 5
500 mg 10–14
Acute Bacterial Exacerbation of Chronic Bronchitis 500 mg 7
Complicated Skin and Skin Structure Infections (SSSI) 750 mg 7–14
Uncomplicated SSSI 500 mg 7–10
Chronic Bacterial Prostatitis 500 mg 28
 Complicated Urinary Tract Infection (cUTI) or
Acute Pyelonephritis (AP)¶
750 mg 5
Complicated Urinary Tract Infection (cUTI) or
Acute Pyelonephritis (AP)#
250 mg 10
Uncomplicated Urinary Tract Infection 250 mg 3
 Inhalational Anthrax (Post-Exposure), adult and pediatric patients > 50 kg and greater than or equal 6 months of age Þ,ß
 Pediatric patients < 50 kg and greater than or equal 6 months of age Þ,ß
500 mg see Table 3 below (2.2) 60 ß

60 ß
Sequential therapy (intravenous to oral) may be instituted at the discretion of the physician.

‡ - Due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae (including multi-drug-resistant strains [MDRSP]), Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydophila pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae

§- Due to Streptococcus pneumoniae (excluding multi-drug-resistant strains [MDRSP]), Haemophilus influenzae, Haemophilus parainfluenzae, Mycoplasma pneumoniae, or Chlamydophila pneumoniae

¶ - This regimen is indicated for cUTI due to Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and AP due to E. coli, including cases with concurrent bacteremia.

# - This regimen is indicated for cUTI due to Enterococcus faecalis, Enterococcus cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa; and for AP due to E. coli.

Þ- Drug administration should begin as soon as possible after suspected or confirmed exposure to aerosolized B. anthracis. This indication is based on a surrogate endpoint. Levofloxacin plasma concentrations achieved in humans are reasonably likely to predict clinical benefit

ß-The safety of LEVAQUIN® in adults for durations of therapy beyond 28 days or in pediatric patients for durations beyond 14 days has not been studied. An increased incidence of musculoskeletal adverse events compared to controls has been observed in pediatric patients. Prolonged LEVAQUIN® therapy in adults should only be used when the benefit outweighs the risk.

Renal Dosing

dialysis [CRCL >50] No change

[20-49]: See below.

[10-19]: See below.


Dosage Adjustment in Patients with Renal Impairment (creatinine clearance <50 mL/min)
Dosage in Normal Renal Function Every 24 hours Creatinine Clearance
20 to 49 mL/min
Creatinine Clearance
10 to 19 mL/min
Hemodialysis or Chronic Ambulatory Peritoneal Dialysis (CAPD)
750 mg 750 mg every 48 hours 750 mg initial dose, then 500 mg every 48 hours 750 mg initial dose, then 500 mg every 48 hours
500 mg 500 mg initial dose, then 250 mg every 24 hours 500 mg initial dose, then 250 mg every 48 hours 500 mg initial dose, then 250 mg every 48 hours
250 mg No dosage adjustment required 250 mg every 48 hours. If treating uncomplicated UTI, then no dosage adjustment is required No information on dosing adjustment is available

Hemodialysis

dialysis Hemodialysis or PD:
See table above.

On dialysis days, schedule dose after dialysis. 

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Please review the latest applicable package insert for additional information and possible updates.  A local search option of this data can be found here.

Disclaimer

The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer
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