Levofloxacin (Lfx)

Therapeutic action

– Antibacterial (fluoroquinolone) with bactericidal activity

Presentation

– 250 mg and 500 mg tablets

Dosage

– Child under 30 kg:
• 6 months-under 5 years: 15 to 20 mg/kg/day in 2 divided doses
• 5 years and over: 10 mg/kg once daily
– Child over 30 kg and adult: 750 to 1000 mg once daily
– Maximum dose: 1000 mg daily
– Patient with severe renal impairment: 750 to 1000 mg/dose, 3 times per week

Weight
(kg)

Daily dose
(mg)

500 mg
tablet

250 mg
tablet

5

75-100

6

90-120

7

105-140

8

120-160

9

135-180

10

150-200

11

165-220

½ tab x 2

12

180-240

½ tab x 2

13

195-260

½ tab x 2

14

210-280

½ tab x 2

15

225-300

½ tab x 2

16

240-320

½ tab x 2

17

255-340

½ tab x 2

18

270-360

½ tab x 2

19

285-380

½ tab x 2

20

200

1 tab

21

210

1 tab

22

220

1 tab

23

230

1 tab

24

240

1 tab

25

250

1 tab

26

260

1 tab

27

270

1 tab

28

280

1 tab

29

290

1 tab


30-35

750

3 tab

36-45

750

3 tab

46-55

1000

2 tab

56-70

1000

2 tab

> 70

1000

2 tab

Contra-indications, adverse effects, precautions

– Do not administer to patients with history of allergy or tendon damage during a previous treatment with a fluoroquinolone.
– Administer with caution to children, adolescents and patients over 60 years (increased risk of tendon damage); patients with risk factors for QT interval prolongation (heart failure, bradycardia, hypokalaemia, etc.) or history of psychiatric disorders or seizures.
– May cause: gastrointestinal disturbances, headache, central nervous system disorders (dizziness, insomnia, depression, etc.), hypersensitivity reactions, photosensitivity, peripheral neuropathy, myalgia, tendinitis, tendon rupture; rarely, crystalluria.
– For the management of adverse effects, see Appendix 10.
– Avoid or monitor combination with drugs that prolong QT interval (amiodarone, bedaquiline, clofazimine, erythromycin, fluconazole, lopinavir, mefloquine, ondansetron, pentamidine, quinine, etc.) and warfarin.
– Do not administer simultaneously with antacids containing magnesium or aluminium, calcium, iron and zinc salts, didanosine (except enteric-coated formulation): administer 2 hours apart.
Pregnancy and breastfeeding: safety is not established, considered as acceptable if vital for the mother.

Monitoring

– Symptomatic monitoring

Patient instructions

– May be taken with food but do not take milk-based product or antacids or multivitamins when taking a tablet, wait two hours.
– Maintain a good fluid intake.
– Protect your skin from sun.

Remarks

– An oral suspension (25 mg/ml) is available, however because of its high concentration of benzyl alcohol, it is contraindicated in children under 3 years. For long-term use in children no safety data are available.
 Storage: below 25°C -  -