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levofloxacin
generic
Black Box Warnings .
Disabling, Potentially Irreversible Serious Reactions
fluoroquinolones assoc. with tendinitis/tendon rupture, peripheral neuropathy, and CNS effects that may occur together; tendinitis/tendon rupture may occur during tx or months after tx D/C; incr. tendinitis/tendon rupture risk in all ages; risk further incr. in older pts >60 yo, pts taking corticosteroids, and pts w/ kidney, heart, or lung transplant; D/C immediately and avoid fluoroquinolone use in pts w/ these serious reactions
Avoid in Myasthenia Gravis
fluoroquinolones may exacerbate muscle weakness in pts w/ myasthenia gravis
Reserve Fluoroquinolone Use
for pts w/ no alternative tx options for acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, or uncomplicated UTI
Adult Dosing .
Dosage forms: TAB: 250 mg, 500 mg, 750 mg; SOL: 25 mg per mL; INJ: various
pneumonia
- [community-acquired]
- Dose: 750 mg PO/IV q24h for at least 5 days; Info: may be part of multi-drug regimen; refer to IDSA guidelines; give oral solution 1h before or 2h after meals
- [hospital-acquired or ventilator-assoc.]
- Dose: 750 mg IV q24h x7 days; Info: may extend duration based on clinical response; refer to IDSA guidelines
prostatitis, chronic bacterial
- [500 mg PO/IV q24h x28 days]
- Info: give oral solution 1h before or 2h after meals
UTI
- [uncomplicated]
- Dose: 250 mg PO/IV q24h x3 days; Info: for pts w/ no alternative tx options; refer to IDSA guidelines; give oral solution 1h before or 2h after meals
- [acute pyelonephritis]
- Dose: 750 mg PO/IV q24h x5 days; Alt: 250 mg PO/IV q24h x10 days; Info: may give w/ ceftriaxone or gentamicin; refer to IDSA guidelines; give oral solution 1h before or 2h after meals
- [complicated]
- Dose: 750 mg PO/IV q24h x5 days; Alt: 250 mg PO/IV q24h x10 days; Info: give oral solution 1h before or 2h after meals
skin/skin structure infections, bacterial
- [uncomplicated]
- Dose: 500 mg PO/IV q24h x7-10 days; Info: give oral solution 1h before or 2h after meals
- [complicated]
- Dose: 750 mg PO/IV q24h x7-14 days; Info: give oral solution 1h before or 2h after meals
anthrax
- [systemic]
- Dose: 750 mg IV q24h for at least 2wk; Info: not 1st-line agent; may use in pregnant women; part of multi-drug regimen; switch to PO abx for post-exposure prophylaxis if inhalational exposure; give oral solution 1h before or 2h after meals
- [cutaneous]
- Dose: 750 mg PO q24h x7-10 days; Info: for non-systemic infection; 1st-line agent; may use in pregnant women; use extended duration for post-exposure prophylaxis if bioterrorism suspected; give oral solution 1h before or 2h after meals
- [post-exposure prophylaxis]
- Dose: 750 mg PO q24h x60 days; Info: not 1st-line agent; give in combo w/ anthrax vaccine; may use in pregnant women; give oral solution 1h before or 2h after meals; may give x42 days or x14 days after last vaccine dose in immunocompetent pts 18-65 yo if anthrax vaccine regimen completed
plague
- [500 mg PO q24h x10-14 days]
- Info: for prophylaxis and tx; may incr. to 750 mg PO q24h; give oral solution 1h before or 2h after meals
chronic bronchitis, acute bacterial exacerbation
- [500 mg PO/IV q24h x7 days]
- Info: for pts w/ no alternative tx options; give oral solution 1h before or 2h after meals
sinusitis, acute bacterial
- [500 mg PO/IV q24h x5-10 days]
- Alt: 750 mg PO/IV q24h x5 days; Info: for pts w/ no alternative tx options; give oral solution 1h before or 2h after meals
infections, chlamydial (off-label)
- [500 mg PO q24h x7 days]
- Info: not 1st-line agent; give oral solution 1h before or 2h after meals
epididymitis (off-label)
- [500 mg PO q24h x10 days]
- Info: give w/ ceftriaxone if chlamydia or gonorrhea suspected; give oral solution 1h before or 2h after meals
PID (off-label)
- [500 mg PO/IV q24h x14 days]
- Info: for pts w/ cephalosporin allergy and low gonorrhea risk; give w/ metronidazole; give oral solution 1h before or 2h after meals
tuberculosis, active (off-label)
- [500-1000 mg PO q24h]
- Info: not 1st-line agent; part of multi-drug regimen; give oral solution 1h before or 2h after meals
febrile neutropenia, chemo-induced (off-label)
- [500-750 mg PO q24h]
- Info: for empiric tx in low-risk pts not on fluoroquinolone prophylaxis; give w/ amoxicillin/clavulanate
infection prophylaxis, surgical (off-label)
- [500 mg IV x1]
- Start: w/in 120min preop
H. pylori infection (off-label)
- [500 mg PO qd x14 days]
- Info: for quinolone-susceptible H. pylori infection only; not 1st-line tx; part of multi-drug regimen; give oral solution 1h before or 2h after meals; search 'H. pylori Tx' for epocrates H. pylori Tx Regimens decision tool
endocarditis (off-label)
- [750 mg IV q24h]
- Info: not 1st-line tx; dose, frequency, duration vary w/ pathogen susceptibility, infection severity, valve type; refer to AHA guidelines
renal dosing
- [tuberculosis]
- CrCl <30: 750-1000 mg 3x/wk
- HD: 750-1000 mg 3x/wk after dialysis; no supplement; PD: not defined
- [all other indications, usual dose 750 mg q24h]
- CrCl 20-49: 750 mg q48h; CrCl <20: 750 mg x1, then 500 mg q48h
- HD: 750 mg x1, then 500 mg q48h, on dialysis days admin. after dialysis; no supplement; PD: 750 mg x1, then 500 mg q48h; no supplement
- [all other indications, usual dose 500 mg q24h]
- CrCl 20-49: 500 mg x1, then 250 mg q24h; CrCl <20: 500 mg x1, then 250 mg q48h
- HD: 500 mg x1, then 250 mg q48h, on dialysis days admin. after dialysis; no supplement; PD: 500 mg x1, then 250 mg q48h; no supplement
- [all other indications, usual dose 250 mg q24h]
- CrCl 10-19: 250 mg q48h; CrCl <10: not defined; Info: no adjustment for uncomplicated UTI
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: TAB: 250 mg, 500 mg, 750 mg; SOL: 25 mg per mL; INJ: various
anthrax, systemic
- [1 mo and older, <50 kg]
- Dose: 16 mg/kg/day IV divided q12h for at least 2wk; Max: 250 mg/dose; Info: not 1st-line agent; part of multi-drug regimen; switch to PO abx x60 days total if inhalational exposure; give oral solution 1h before or 2h after meals
- [1 mo and older, >50 kg]
- Dose: 500 mg IV q24h for at least 2wk; Info: not 1st-line agent; part of multi-drug regimen; switch to PO abx x60 days total if inhalational exposure; give oral solution 1h before or 2h after meals
anthrax, cutaneous
- [1 mo and older, <50 kg]
- Dose: 16 mg/kg/day PO divided q12h x7-10 days; Max: 250 mg/dose; Info: for non-systemic infection; give abx x60 days total if bioterrorism suspected; give oral solution 1h before or 2h after meals
- [1 mo and older, >50 kg]
- Dose: 500 mg PO q24h x7-10 days; Info: for non-systemic infection; give abx x60 days total if bioterrorism suspected; give oral solution 1h before or 2h after meals
anthrax, post-exposure prophylaxis
- [1 mo and older, <50 kg]
- Dose: 16 mg/kg/day PO divided q12h x60 days; Max: 250 mg/dose; Info: not 1st-line agent; give oral solution 1h before or 2h after meals
- [1 mo and older, >50 kg]
- Dose: 500 mg PO q24h x60 days; Info: not 1st-line agent; not 1st-line agent; give oral solution 1h before or 2h after meals
plague
- [6 mo and older, <50 kg]
- Dose: 16 mg/kg/day PO divided q12h x10-14 days; Max: 250 mg/dose; Info: for prophylaxis and tx; give oral solution 1h before or 2h after meals
- [6 mo and older, >50 kg]
- Dose: 500 mg PO q24h x10-14 days; Info: for prophylaxis and tx; give oral solution 1h before or 2h after meals
sinusitis, acute bacterial (off-label)
- [children]
- Dose: 10-20 mg/kg/day PO/IV divided q12-24h x10-14 days; Max: 750 mg/day; Info: give oral solution 1h before or 2h after meals
community-acquired pneumonia, bacterial (off-label)
- [IV route, 6 mo-4 yo]
- Dose: 16-20 mg/kg/day IV divided q12h x10 days; Max: 750 mg/day; Info: may switch to PO regimen when possible to complete course
- [IV route, 5-16 yo]
- Dose: 8-10 mg/kg/dose IV q24h x10 days; Max: 750 mg/day; Info: may switch to PO regimen when possible to complete course
- [PO route, 6 mo-4 yo]
- Dose: 16-20 mg/kg/day PO divided q12h x7-10 days; Max: 750 mg/day; Info: give oral solution 1h before or 2h after meals
- [PO route, 5-16 yo]
- Dose: 8-10 mg/kg/dose PO q24h x7-10 days; Max: 750 mg/day; Info: give oral solution 1h before or 2h after meals
community-acquired pneumonia, atypical (off-label)
- [IV route, 6 mo-4 yo]
- Dose: 16-20 mg/kg/day IV divided q12h x10 days; Max: 750 mg/day; Info: may switch to PO regimen when possible to complete course
- [IV route, 5-16 yo]
- Dose: 8-10 mg/kg/dose IV q24h x10 days; Max: 750 mg/day; Info: may switch to PO regimen when possible to complete course
- [PO route, adolescents w/ skeletal maturity]
- Dose: 500 mg PO q24h x7-10 days; Info: give oral solution 1h before or 2h after meals
infections, chlamydial (off-label)
- [adolescents]
- Dose: 500 mg PO q24h x7 days; Info: not 1st-line agent; give oral solution 1h before or 2h after meals
epididymitis (off-label)
- [preadolescents >45 kg and adolescents]
- Dose: 500 mg PO q24h x10 days; Info: give w/ ceftriaxone if chlamydia or gonorrhea suspected; give oral solution 1h before or 2h after meals
PID (off-label)
- [adolescents]
- Dose: 500 mg PO/IV q24h x14 days; Info: for pts w/ cephalosporin allergy and low gonorrhea risk; give w/ metronidazole; give oral solution 1h before or 2h after meals
tuberculosis, active (off-label)
- [15-20 mg/kg/dose PO q24h]
- Info: not 1st-line agent; part of multi-drug regimen; give oral solution 1h before or 2h after meals
otitis media, acute (off-label)
- [6 mo-4 yo]
- Dose: 16-20 mg/kg/day PO/IV divided q12h; Info: duration varies w/ age, infection severity; give oral solution 1h before or 2h after meals
- [5 yo and older]
- Dose: 10 mg/kg/dose PO/IV q24h; Max: 750 mg/dose; Info: duration varies w/ age, infection severity; give oral solution 1h before or 2h after meals
infection prophylaxis, surgical (off-label)
- [1 yo and older]
- Dose: 10 mg/kg/dose IV x1; Start: w/in 120min preop; Max: 500 mg/dose
renal dosing
- [adjust dose frequency]
- CrCl 10-29: give usual divided dose q24h; CrCl <10: give usual divided dose q48h
- HD: give usual divided dose q48h, on dialysis days admin. after dialysis; no supplement; PD: give usual divided dose q48h; no supplement
hepatic dosing
- [not defined]