Levofloxacin dosage, forms, and strengths

Levofloxacin (brand: Levaquin) is the generic name of the third generation fluoroquinolone antibiotics used for the management of various bacterial infections- especially those found in the urinary and lower respiratory tract infections. Fluoroquinolones are the newer versions of the traditional quinolone antibiotics, which can be taken less frequently and have a wider coverage against many different types of bacteria. The brand name for this medication is Levaquin or Levaquin Leva-pak. This antibiotic is usually administered by mouth or as an injectable for intravenous therapy.

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Levofloxacin forms and strengths

Levofloxacin dosage forms include tablets or solutions. Here are examples of the different forms found for levofloxacin:

• Tablets: 250 milligrams (mg), 500 mg, or 750 mg

• Oral suspension: 100 mg, 200 mg, 480 mg of 25 mg per milliliter (mL)

• Injectable solution: 20 mL or 40 mL of 25 mg/mL for intravenous therapy

• Ophthalmic drops: 5 mL of 0.5% bottle

Levofloxacin dosage for adults

There are several different bacterial infections that can be managed with a fluoroquinolone antibiotic. Those specific to levofloxacin include:

• Anthrax treatment and prevention

• Bacteremia

• Bacterial infection

• Bladder infection and prophylaxis 

• Bone infection

• Bronchitis

• Chlamydia infection

• Cutaneous bacillus anthracis

• E. coli infection

• Infectious diarrhea

• Intra-abdominal infection

• Joint infection

• Kidney infections

• Plague treatment and prophylaxis

• Pneumonia

• Prostatitis

• Salmonella infection

• Sinusitis

• Skin structure infections

• Soft tissue infection

• Streptococcal infection

• Traveler's diarrhea

• Urinary tract infection

*There are several off-label treatments for other health conditions that are NOT listed

Levofloxacin dosage for anthrax

Levofloxacin is approved for the treatment of inhalation anthrax caused by Bacillus anthracis. The length of time needed for the medication varies based on the severity of the infection being treated.

Systemic anthrax

• Administer 750 mg IV every 24 hours for two weeks

• Not part of the first-line treatments for systemic anthrax

• When used it is part of a multi-drug treatment plan

Cutaneous anthrax

• Take one 750 mg tablet every 24 hours for seven to 10 days

• First-line treatment

Post-exposure prophylaxis of anthrax

• Take one 750 mg tablet every 24 hours for 60 days

• Not a first-line treatment

• Recommend to be given along with anthrax vaccine

Levofloxacin dosage for bronchitis

Levofloxacin is approved for the treatment of acute bacterial exacerbation of chronic bronchitis when caused by Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, or Moraxella catarrhalis pathogens.

• Take one 500 mg tablet or IV every 24 hours for seven days

• Use if no other options are available

Levofloxacin dosage for plague

Levofloxacin is approved for the treatment and prevention of pneumonic and septicemic plague caused by Yersinia pestis.

• Take one 500 mg tablet or IV every 24 hours for 28 days

• Can also use 750 mg if needed

Levofloxacin dosage for pneumonia

Levofloxacin is approved for the treatment of community-acquired pneumonia and nosocomial pneumonia (hospital-acquired) caused by Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydophila pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae.

• Community-acquired: Take one 750 mg tablet or IV every 24 hours for five days

• Hospital-acquired: Administer 750 mg IV every 24 hours for seven days

Levofloxacin dosage for prostatitis

Levofloxacin is approved for the treatment of chronic bacterial prostatitis caused by Escherichia coli, Enterococcus faecalis, or methicillin-susceptible Staphylococcus epidermidis.

• Take one 500 mg tablet every 24 hours for 10 to 14 days

Levofloxacin dosage for sinusitis

Levofloxacin is approved for the treatment of acute bacterial sinusitis caused by Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis.

• Take 750 mg tablet or IV every 24 hours for five days

• Only use if no other option is available

Levofloxacin dosage for skin infections

Levofloxacin is approved for the treatment of acute bacterial uncomplicated and complicated skin infections when caused by Staphylococcus aureus, Enterococcus faecalis, Streptococcus pyogenes, or Proteus mirabilis pathogens.

• Uncomplicated skin infections: Take one 500 mg tablet or IV every 24 hours for seven to 10 days

• Complicated skin infections: Take one 750 mg tablet or IV every 24 hours for seven to 14 days

Levofloxacin dosage for UTI

Levofloxacin is approved for the treatment of uncomplicated urinary tract infections as well as complicated urinary tract infections due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa.

• Uncomplicated UTI: Take one 250 mg tablet or IV every 24 hours for thre days

• Acute pyelonephritis: Take one 750 mg tablet or IV every 24 hours for five days

• Complicated UTI: Take one 750 mg tablet or IV every 24 hours for five days

Levofloxacin dosage for children

Levofloxacin may be used in pediatric patients to treat anthrax or plague.

Levofloxacin dosage for pediatric anthrax

Levofloxacin is approved for the treatment in pediatric patients of inhalation anthrax caused by Bacillus anthracis for those aged 1 month or older.

Systemic anthrax

• Less than 50 kg:

  • Administer 16 mg/kg/day IV divided every 12 hours for two weeks

  • Maximum dosage: 250 mg/dose

  • Not part of the first-line treatments for systemic anthrax

  • When used it is part of a multi-drug treatment plan

• Greater than 50 kg:

  • 500 mg IV every 24 hours for two weeks

Cutaneous anthrax

• Less than 50 kg:

  • Administer 16 mg/kg/day IV divided every 12 hours for seven to 10 days

  • Maximum dosage: 250 mg/dose

• Greater than 50 kg:

  • 500 mg IV every 24 hours for seven to 10 days 

Post-exposure prophylaxis of anthrax

• Less than 50 kg:

  • Administer 16 mg/kg/day IV divided every 12 hours for 60 days

  • Maximum dosage: 250 mg/dose

  • Not part of the first-line treatments 

• Greater than 50 kg:

  • 500 mg IV every 24 hours for 60 days

Levofloxacin dosage for pediatric plague

Levofloxacin is approved for the treatment and prevention of plague caused by Yersinia pestis in pediatric patients aged 6 months or older.

• Less than 50 kg:

  • Administer 16 mg/kg/day IV divided every 12 hours for two weeks

  • Maximum dosage: 250 mg/dose

  • Not part of the first-line treatments for systemic anthrax

  • When used it is part of a multi-drug treatment plan

• Greater than 50 kg:

  • 500 mg IV every 24 hours for two weeks

Levofloxacin dosage restrictions

Typically levofloxacin is not the first antibiotic of choice for minor bacterial infections due to the various adverse effects associated with its use. 

Tendinitis or tendon rupture

Levofloxacin has the potential to cause tendinitis or tendon rupture during or after its use. All ages may develop this tendon complication, but the risk factors increase in those older than 60 years of age, those taking corticosteroids, or patients with kidney, heart, or lung transplants. 

Myasthenia gravis

Patients with a history of myasthenia gravis should also avoid levofloxacin as it may cause muscle weakness. If there is a known reaction to other fluoroquinolones, such as ciprofloxacin, then levofloxacin should also be avoided. Other antibiotics should be considered first when possible, and levofloxacin should only be considered when drug-resistant bacteria infections exist or for the more complicated infections.

Low potassium

If there is a history of low levels of potassium in your blood (hypokalemia), levofloxacin should also be avoided. 

Renal impairment

Patients with renal impairment must be particularly cautious when using levofloxacin as modifications are required. Formulations for renal impairment involve monitoring the creatinine clearance. 

Dosing for 750 mg:

• Creatinine clearance 20-49:750 mg every 48 hours

• Creatinine clearance less than 20: 750 mg once then 500 mg every 48 hours

• Hemodialysis patients: 750 mg once then 500 mg every 48 hours; give medication after dialysis on those days

• Peritoneal dialysis patients: 750 mg once then 500 mg every 48 hours

• No supplements required

Dosing for 500 mg:

• Creatinine clearance 20-49: 500 mg once then 250 mg then every 24 hours

• Creatinine clearance less than 20: 500 mg once then 250 mg then every 48 hours

• Hemodialysis patients: 500 mg once then 250 mg then every 48 hours; give medication after dialysis on those days

• Peritoneal dialysis patients: 500 mg once then 250 mg then every 48 hours

• No supplements required

Dosing for 250 mg:

• Creatinine clearance 10-19: 250 mg every 48 hours

• No adjustments were provided for hemodialysis and peritoneal dialysis patients

Levofloxacin dosage for pets 

Levofloxacin is only approved by the United States Food and Drug Administration (FDA) for the management of bacterial infections in humans. However, a veterinarian can also prescribe this medication for pets off-label when needed for serious bacterial infections in the urinary tract, prostate, skin, ears, or lungs. Typically this medication is prescribed as a tablet or liquid solution that is given no longer than 14 days.

How to take levofloxacin

Here are some tips on how to properly take levofloxacin when prescribed by your healthcare provider:

• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.

• Your doctor will tell you how much medicine to use. Do not use more than directed. Take your medicine at the same time each day.

• Oral solution: Take it one hour before or two hours after you eat. Measure the oral liquid medicine with a marked measuring spoon, oral syringe, or medicine cup.

• Tablet: Take it with or without food.

• Take all of the medicine in your prescription to clear up your infection, even if you feel better after the first few doses.

• Drink extra fluids so you will urinate more often and help prevent kidney problems.

• This medicine should come with a Medication Guide. Ask your pharmacist for a copy if you do not have one.

Levofloxacin dosage FAQs

What happens if I miss a dose of levofloxacin?

Sometimes a dose may get missed. If this happens, take the next dose as soon as possible but if the next dose is soon only take this one. Never take two doses together.

How long can you take levofloxacin?

The length of time required to take levofloxacin varies, so it is important to complete the antibiotic as instructed by healthcare professionals. 

Can you overdose on levofloxacin?

Overdoses may occur if levofloxacin is not taken as directed by your healthcare provider. If any serious allergic reactions occur, seek emergency medical attention immediately. Many adverse reactions are associated with this medication. Some serious side effects include hypersensitivity, peripheral neuropathy, tendinitis or tendon rupture, myasthenia gravis exacerbation, low blood glucose, aortic aneurysm or dissection, QT interval prolongation, torsades de pointes, kidney or liver damage, seizures, and depression or suicidality.

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What interacts with levofloxacin?

Many medications may interact with levofloxacin. It is important that all medications being taken should be discussed with your healthcare specialist. Some signs of drug interactions may include:

• Binds to cations (different minerals such as zinc, iron, and calcium) within the digestive tract, which make it difficult for the body to absorb levofloxacin

• Binds to polyvalent cations (examples include antacids) that may interfere with your body absorbing this antibiotic effectively when used simultaneously 

• High blood sugars

• Low blood sugars

• lowers seizure threshold

• QT prolongation

The following drugs are contraindications with the use of levofloxacin:

• Cisapride

• Dronedarone

• Pimozide

• Thioridazine

More commonly used medications that should be avoided if possible when considering levofloxacin are:

• Blood thinners (warfarin, coumadin)

• Nonsteroidal anti-inflammatories (Motrin, Aleve, ibuprofen)

• Steroids (corticosteroids, prednisone)

• Diabetic medications (insulin) 

• Heart medications

• Water pills

• Depression medications

• Theophylline 

Many medications can be used with levofloxacin but should be monitored closely as they will need to be taken at least two hours before or after taking levofloxacin to reduce risk factors associated with this medication. These medications include:

• Antacids (Those containing magnesium or aluminum)

• Didanosine

• Sucralfate 

• Multivitamin supplements (Those containing aluminum, iron, magnesium, or zinc)

What happens when you mix levofloxacin and alcohol?

There is no known contraindication when taking levofloxacin with alcohol. It is always recommended that you discuss this first with your healthcare provider, as alcohol may heighten some of the side effects associated with this medication.

Is it safe to take levofloxacin during pregnancy?

Although levofloxacin is an effective antibacterial treatment option, alternatives should be considered during pregnancy and it should only be used when the benefits outweigh the risks. There is no clear data of its safety to the fetus and there is a concern for spontaneous abortion. 

It is recommended that levofloxacin be avoided while breastfeeding. If an alternative is not available, breastfeeding can resume after the medication has been discontinued for two days. Breastfeeding can resume after four to six hours of taking the medication when being treated for anthrax. 

Related resources for levofloxacin dosages:

• New classification and update on the quinolone antibiotics, American Family Physician

• Adult dosing, Epocrates

• Pediatric dosing, Epocrates

• Levofloxacin for dogs, DailyPuppy

• Drug interactions, Epocrates

• Pregnancy/lactation, Epocrates