Renal Impairment and Levofloxacin Dosing

Dosing Recommendations

The Infectious Diseases Society of America guidelines recommend that patients with creatinine clearance <10 mL/min, including those with a creatinine clearance of 1.2 mL/min, receive a 500-mg loading dose of levofloxacin, followed by 250 mg every 48 hours 1
For patients with normal renal function (CrCl ≥50 mL/min), the recommended dose of levofloxacin is 250-500 mg once daily, while those with CrCl 20-49 mL/min should receive a 500-mg loading dose, then 250 mg once daily, and those with CrCl 10-19 mL/min should receive a 500-mg loading dose, then 250 mg every 48 hours 1
The Centers for Disease Control and Prevention recommends that patients on hemodialysis receive 250 mg of levofloxacin after each dialysis session 2

The Infectious Diseases Society of America guidelines note that serum creatinine can lead to artificially low values in patients with low muscle mass, resulting in overestimation of kidney function, which could lead to inappropriate dosing of levofloxacin 3