When you look up dosing for levofloxacin for community acquired pneumonia (CAP), you will find that both of the following options are approved:

• Levofloxacin 500 mg IV/PO daily x 7-14 days
• Levofloxacin 750 mg IV/PO daily x 5 days

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.

So why should you choose the 750 mg daily x 5 day regimen?

• Higher doses maximize the concentration-dependent pharmacokinetic profile of the drug
• Higher doses and shorter duration may be associated with less drug resistance
• Patients subjectively report feeling better at day 3 with the higher dose regimen

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! 

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• The incidence of Staphylococcus aurea as a urinary pathogen is increasing, however, this finding may represent more than a simple urinary tract infection.
• One review found an 8-21%rate of association between S. aureus in the urine with bacteremia.
• Additional work up, including blood cultures, may be warranted in patients with systemic symptoms, lack of access to follow up, and no urinary tract pathology or instrumentation.

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