• Type: Fluoroquinolone
  • Dosage Forms: PO, IV, Inhaled
  • Common Trade Names: Levaquin

Adult Dosing


  • Community acquired
    • 750mg PO/IV q24h x 5 days
  • Nosocomial
    • 750 gm PO/IV q24h x 7-14 days


  • 500 MG PO/IV q24h x 28 days


  • 750mg PO/IV q24h x 5 days

Skin infection

  • Uncomplicated
    • 500mg PO/IV q24h x 7-10 days
  • Complicated
    • 750mg PO/IV q24h x 7-14 days


  • Uncomplicated
    • 250mg PO/IV q24h x 3days
  • Complicated
    • 750mg PO/IV q24h x 5 days

Pediatric Dosing

Pneumonia (Community acquired)

  • 6 months - 4 years old
    • 16-20mg/kg/day IV or PO, divided q12h x 10 days
  • 5-16 years old
    • 8-10mg/kg/day IV or PO, divided q12h x 10 days

Special Populations

  • Pregnancy Rating: C
  • Lactation: Probably Safe
  • Renal Dosing
    • Adult
      • If usual dose is 750mg qd
        • CrCl 20-49: 750mg q48h
        • CrCl 10-19: 750mg x1 then 500mg q48h
        • CrCl <10: Not defined
        • HD/PD: No supplement
      • If usual dose is 500mg qd
        • CrCl 20-49: 500mg x1, then 250mg q24h
        • CrCl 10-19: 500mg x1, then 250mg q48h
        • CrCl <10: Not defined
        • HD/PD: No supplement
      • If usual dose is 250mg qd
        • CrCl 10-19: 250mg q48h
        • CrCl <10: Not defined
        • HD/PD: No supplement
    • Pediatric
      • CrCl 10-29: Give q24h
      • CrCl <10: Give q48h
      • HD/PD: No supplement
  • Hepatic Dosing: not defined


Adverse Reactions


  • Anaphylaxis, hypersensitivity
  • Phototoxicity
  • C. difficile diarrhea
  • Seizures
  • Depression / suicidal ideation
  • Torsades de Pointes
  • Vasculitis
  • Renal toxicity
  • Hepatic toxicity
  • Tendon rupture/tendinitis (black box warning, inc aged 60+/immunosuppressed/corticosteroid use)
  • Myasthenia exacerbation
  • Severe Hypoglycemia [1]



  • Half-life: 6-8 h
  • Metabolism: CYP450
  • Excretion: Urine
  • Mechanism of Action: Bactericidal, inhibits DNA gyrase / Topoisomerase IV

Antibiotic Sensitivities[2]

Group Organism Sensitivity
Gram PositiveStrep. Group A, B, C, GS
Strep. PneumoniaeS
Viridans strepS
Strep. anginosus gpS
Enterococcus faecalisS
Enterococcus faeciumR
Staph. EpidermidisS
C. jeikeiumX1
L. monocytogenesS
Gram NegativesN. gonorrhoeaeI
N. meningitidisS
Moraxella catarrhalisS
H. influenzaeS
E. coliS
Klebsiella spS
E. coli/Klebsiella ESBL+S
E coli/Klebsiella KPC+R
Enterobacter sp, AmpC negS
Enterobacter sp, AmpC posS
Serratia spS
Serratia marcescensX1
Salmonella spS
Shigella spS
Proteus mirabilisS
Proteus vulgarisS
Providencia sp.S
Morganella sp.S
Citrobacter freundiiS
Citrobacter diversusS
Citrobacter sp.S
Aeromonas spS
Acinetobacter sp.I
Pseudomonas aeruginosaI
Burkholderia cepaciaX1
Stenotrophomonas maltophiliaI
Yersinia enterocoliticaS
Francisella tularensisX1
Brucella sp.X1
Legionella sp.S
Pasteurella multocidaS
Haemophilus ducreyiX1
Vibrio vulnificusX1
MiscChlamydophila spS
Mycoplasm pneumoniaeS
Rickettsia spX1
Mycobacterium aviumX1
Bacteroides fragilisR
Prevotella melaninogenicaS
Clostridium difficileR
Clostridium (not difficile)S
Fusobacterium necrophorumX1
Peptostreptococcus sp.S


  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also


  1. FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions. US Food and Drug Administration. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm612995.htm. Updated July 10, 2018. Accessed Oct 22, 2018.
  2. Sanford Guide to Antimicrobial Therapy 2014
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