Levofloxacin Dose Adjustment CKD — ESENeph MCQ
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Correct answer: E — Levofloxacin requires dose reduction in CKD – typical adjustment at eGFR <50 is 250 mg daily or 500 mg alternate days; accumulation increases risk of tendinopathy, QT prolongation, seizures, and C.difficile
Fluoroquinolones are renally cleared and require dose adjustment in CKD. For Levofloxacin at eGFR 10-20: loading dose 500 mg then 250 mg daily (BNF). Accumulation increases serious adverse effects: tendon rupture (particularly with concurrent corticosteroids – common in nephrology patients), QT prolongation (additive with other QT-prolonging drugs and electrolyte disturbances in CKD), CNS effects (confusion, seizures), and C.difficile risk. Ciprofloxacin also requires renal dose adjustment. Moxifloxacin is hepatically cleared and does not need renal adjustment but has greater QT prolongation risk.
Reference: BNF 2024 – Levofloxacin; NICE – Antimicrobial Prescribing