Levofloxacin Use in Elderly Men with CKD Stage 2 and Bacterial Sinusitis

Dosing Considerations

Standard dosing of levofloxacin 750 mg once daily for 5 days or 500 mg once daily for 10 days can be used without modification in CKD stage 2, as dose adjustment is only required when creatinine clearance falls below 50 mL/min, according to the American Thoracic Society 1
If renal function declines to CKD stage 3 or worse (CrCl <50 mL/min), switch to levofloxacin 750-1,000 mg per dose three times per week (not daily), as recommended by the American Thoracic Society 1

Levofloxacin demonstrates excellent activity against the three typical pathogens of acute bacterial sinusitis: Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, with clinical success rates above 90% for all three organisms, according to the American Academy of Otolaryngology-Head and Neck Surgery 2
The European Society of Clinical Microbiology and Infectious Diseases recommends reserving fluoroquinolones active against pneumococci (levofloxacin, moxifloxacin) for situations where major complications are likely or after failure of first-line therapy 4
Levofloxacin should be considered first-line for frontal, fronto-ethmoidal, or sphenoidal sinusitis due to higher complication risk, as suggested by the European Society of Clinical Microbiology and Infectious Diseases 4

Avoid coadministration with multivalent cations (magnesium, aluminum, iron, calcium-containing antacids or supplements) which inhibit gastrointestinal absorption, as advised by the American Academy of Otolaryngology-Head and Neck Surgery 2
Space levofloxacin at least 2 hours before or after these products, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 2