Levofloxacin Dosing and Duration for Pneumonia

Community-Acquired Pneumonia (CAP)

The American College of Cardiology is not mentioned, however, the Infectious Diseases Society of America recommends levofloxacin 750 mg once daily for 5 days for community-acquired pneumonia, which provides equivalent efficacy to the traditional 500 mg daily for 10 days while maximizing bacterial killing and improving compliance 1, 2
For outpatients with comorbidities, levofloxacin 500 mg once daily for 7-10 days is appropriate 1
The 750 mg dose maximizes concentration-dependent bacterial killing and reduces potential for resistance emergence 1
For hospitalized patients without risk factors for Pseudomonas aeruginosa, levofloxacin 750 mg IV/oral once daily for 5-7 days as monotherapy is recommended 1, 2

For Mycoplasma pneumoniae or Chlamydophila pneumoniae, levofloxacin 500 mg once daily is recommended for adolescents with skeletal maturity 5
For Legionella pneumophila, levofloxacin 750 mg once daily has the most clinical data among fluoroquinolones 2
For Pseudomonas aeruginosa, levofloxacin 750 mg daily MUST be combined with antipseudomonal beta-lactam 1, 2, 3

The standard duration is 5-7 days for responding patients with the 750 mg dose 1, 2
Treatment should generally not exceed 8 days in responding patients 1, 2, 4

For children with atypical pneumonia (>7 years old), levofloxacin 16-20 mg/kg/day divided every 12 hours for children 6 months to 5 years (maximum 750 mg/day) is recommended 5
For adolescents with skeletal maturity, levofloxacin 500 mg once daily is recommended 5

Do NOT use levofloxacin if patient received fluoroquinolones within the past 90 days due to high risk of resistant organisms 4
Use cautiously in patients with risk or suspicion of tuberculosis, as levofloxacin may delay TB diagnosis and increase fluoroquinolone resistance 3
Levofloxacin does NOT cover MRSA adequately 4
Adjust dose in severe renal impairment or dialysis 1