Levofloxacin is used to treat and prevent drug-resistant tuberculosis in children. We assessed levofloxacin serum drug concentrations for 24 children 2–10 years old receiving levofloxacin-based tuberculosis preventive therapy in Karachi, Pakistan. Only 9 (37.5%) children achieved adequate drug exposure. Target serum drug concentration was met in 4 (26.6%) of 15 children dosed consistently with World Health Organization recommendations, and 4 (80.0%) of 5 who received higher-than-recommended doses. Levofloxacin dosing recommendations may require reevaluation.
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