Antibiotic Recommendations During Levofloxacin Suspension Shortage

Antibiotic Recommendations During Levofloxacin Suspension Shortage

Patient requiring levofloxacin treatment or prophylaxis
Oral tablet clinically appropriate based on weight?
Yes
No

Levofloxacin Tablet (Preferred)
May be crushed

Table 1: Dosing by Weight

Table 2: Administration Instructions
Compounded Levofloxacin Suspension Available?
Discuss with Pharmacy; may require preauthorization
Compounded levofloxacin suspension is available at CHOP inpatient and retail pharmacy at University City and KOPH campuses
Yes
No
Levofloxacin 50 mg/ml compounded suspension
Levofloxacin Alternative (least preferred)
Primary prophylaxis for AML, BMT, relapsed ALL: ciprofloxacin
Treatment of febrile neutropenia in low-risk host: ciprofloxacin
Other indications require individualized decision -making – discuss with ID/ASP if needed
Table 1. Levofloxacin Tablet Dosing by Weight
Weight (kg) Levofloxacin Dose Number of Tablets
< 5.6 Compounded suspension or alternative
5.6-8.6 62.5 mg One quarter 250 mg
8.7-11.1 Compounded suspension or alternative
11.2-17.2 125 mg Half 250 mg
17.3-22.4 187.5 mg Three-quarters of 250 mg tablet
22.5-34.4 250 mg One
34.5-44.9 375 mg One 250 mg + half 250 mg
45-67.4 500 mg One
> 67.4 750 mg One
Table 2. Tablet Administration Instructions
PO Crush tablet to fine powder and disperse contents into juice, apple sauce, or pudding and immediately consume
Feeding Tube
  • Crush tablet to fine powder and disperse contents into 15-30 mL of water and immediately administer per tube
  • Flush with 10 mL of water