Title: Levofloxacin dosing for CAP<br/>Author: Jill Logan<br/><a href='mailto:1765'>[Click to email author]</a><hr/><p>
When you look up dosing for levofloxacin for community acquired pneumonia (CAP), you will find that both of the following options are approved:</p>
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<li>
Levofloxacin 500 mg IV/PO daily x 7-14 days</li>
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Levofloxacin 750 mg IV/PO daily x 5 days</li>
</ul>
<p>
This is based on a multicenter, randomized, double-blind, active treatment trial comparing these two regimens in CAP (mild to severe). This non-inferiority trial shows that the 750 mg dose of levofloxacin for 5 days is "at least as effective and well tolerated" as the 500 mg dose of levofloxacin for 10 days.</p>
<p>
So why should you choose the 750 mg daily x 5 day regimen?</p>
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<li>
Higher doses maximize the concentration-dependent pharmacokinetic profile of the drug</li>
<li>
Higher doses and shorter duration may be associated with less drug resistance</li>
<li>
Patients subjectively report feeling better at day 3 with the higher dose regimen</li>
</ul>
<p>
As alway with levofloxacin, don't forget to renally dose adjust subsequent doses when writting a script or scheduled inpatient order for patients with reduced creatinine clearance! </p>
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<fieldset><legend>References</legend>
<p>
Dunbar LM, Wunderink RG, Habib MP, et al. High-dose, short-course levofloxacin for community-acquired pneumonia: A new treatment paradigm. Clin Infect Dis. 2003;37:752-60.</p>
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