LEVAQUIN DOSE/FREQUENCY CHANGE FORM

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PATIENT NAME ROOM NUMBER


The following medication has been ordered:



Based on the Cockroft and Gault Equation and a serum creatinine of drawn on , the estimated creatinine clearance is ml/min. Based on the above CrCl, it is recommended that the dose of Levaquin be changed to:



                                                                                   Pharmacist's Name
Levofloxacin Dosing with Renal Function Impairment
Renal status Initial dose Subsequent dose
Acute bacterial exacerbation of chronic bronchitis/Community-acquired pneumonia/Acute maxillary sinusitis/Uncomplicated SSSI
Crcl from 50 to 80 ml/min
Crcl from 20 to 49 ml/min
Crcl from 10 to 19 ml/min
Hemodialysis
CAPD
No dosage adjustment required
500 mg 250 mg every 24 hours
500 mg 250 mg every 48 hours
500 mg 250 mg every 48 hours
500 mg 250 mg every 48 hours
Complicated UTI/Acute pyelonephritis/Uncomplicated UTI
CrCl >20 ml/min
CrCl from 10 to 19 ml/min
No dosage adjustment required
250 mg 250 mg every 48 hours

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