Maximum Dose of Intravenous Levofloxacin

Standard Maximum Dosing for Adults

The maximum recommended dose of intravenous levofloxacin is 750 mg once daily for adults with normal renal function, which has been validated for severe infections including nosocomial pneumonia, complicated skin and skin structure infections, and community-acquired pneumonia 1, 2
750 mg IV once daily is the established maximum dose for most severe bacterial infections in adults with normal renal function 1, 2, 3

For nosocomial pneumonia, 750 mg IV once daily for 7-14 days is recommended 1, 2
For complicated skin and skin structure infections, 750 mg IV once daily for 7-14 days is recommended 1, 2
For severe community-acquired pneumonia, 750 mg IV once daily is recommended 1, 2, 3
For drug-resistant tuberculosis, 750-1,000 mg once daily (maximum 1,000 mg) is recommended 4, 3

For children ≥5 years, the maximum dose is 750 mg once daily (calculated as 10 mg/kg, not to exceed 750 mg) 4, 5
For children 6 months to <5 years, the maximum dose is 750 mg/day total (given as 10 mg/kg divided every 12 hours due to faster clearance) 4, 6

For creatinine clearance <50 mL/min, reduce to 750 mg three times weekly (not daily) 4, 3
Levofloxacin is 80% renally cleared, making dose adjustment essential to prevent accumulation 4
No supplemental doses are needed after hemodialysis 4
No dose adjustment is required for hepatic impairment, as hepatic metabolism is minimal 4

Never exceed 1,000 mg daily, even in severe infections, as higher doses have not been studied and may increase toxicity risk 4, 3

Do not administer levofloxacin within 2 hours of antacids or medications containing divalent cations (calcium, magnesium, aluminum, iron), as these markedly decrease fluoroquinolone absorption even with IV administration due to chelation effects 4

The American Thoracic Society and Infectious Diseases Society of America recommend levofloxacin 500 mg once daily orally or IV for community-acquired pneumonia (non-severe) in adults with normal renal function 7, 8
The American College of Chest Physicians suggests that levofloxacin is administered once daily across virtually all approved indications, including community-acquired pneumonia (non-severe), with a dosage of 500 mg once daily orally or IV 7, 8

For severe community-acquired pneumonia requiring ICU care, the Infectious Diseases Society of America guidelines suggest 500 mg IV twice daily as an alternative to 750 mg once daily, particularly when used in combination therapy, with a strength of evidence considered moderate 7, 8

The Pediatric Infectious Diseases Society recommends that children under 5 years require twice-daily dosing (10 mg/kg divided every 12 hours, maximum 750 mg/day total) due to faster drug clearance in this age group, with a high strength of evidence 9
The American Academy of Pediatrics suggests that children 5 years and older can receive once-daily dosing at 10 mg/kg (maximum 750 mg), with a moderate strength of evidence 9

The Centers for Disease Control and Prevention recommend not confusing levofloxacin with ciprofloxacin dosing—ciprofloxacin requires twice-daily administration, while levofloxacin is once daily, with a high strength of evidence 10