What is the recommended dosage of ofloxacin (fluoroquinolone antibiotic) for adults and pediatric patients?

Ofloxacin Dosage for Adults and Pediatric Patients

For adults, ofloxacin is typically dosed at 400 mg every 12 hours orally, while for pediatric patients, the recommended dose is 7.5 mg/kg every 12 hours orally (maximum 400 mg/dose). 1, 2

Adult Dosing

Standard Dosing

• Oral administration: 200-400 mg every 12 hours depending on infection type 2
• Duration: Typically 3-14 days based on infection type and severity

Specific Infection Dosing (Adults)

• Acute bacterial exacerbation of chronic bronchitis: 400 mg every 12 hours for 10 days
• Community-acquired pneumonia: 400 mg every 12 hours for 10 days
• Uncomplicated skin/skin structure infections: 400 mg every 12 hours for 10 days
• Acute uncomplicated gonorrhea: 400 mg single dose
• Nongonococcal cervicitis/urethritis: 300 mg every 12 hours for 7 days
• Pelvic inflammatory disease: 400 mg every 12 hours for 10-14 days
• Uncomplicated cystitis: 200 mg every 12 hours for 3-7 days
• Complicated UTIs: 200 mg every 12 hours for 10 days
• Prostatitis: 300 mg every 12 hours for 6 weeks 2

Dosage Adjustments for Adults

• Renal impairment:
  • CrCl 20-50 mL/min: Normal dose once daily
  • CrCl <20 mL/min: Half the usual dose once daily 2
• Hepatic impairment: Maximum 400 mg per day in severe liver dysfunction 2

Pediatric Dosing

Standard Dosing

• Oral administration: 7.5 mg/kg every 12 hours (maximum 400 mg/dose) 1
• Age restrictions: Generally not FDA-approved for routine use in children under 18 years

Special Considerations for Pediatric Use

• Ofloxacin is generally used as an alternative agent in pediatric patients when other options are not suitable 1
• Fluoroquinolones should be used cautiously in children due to concerns about effects on developing cartilage 1
• For specific infections like plague, ofloxacin may be used as an alternative agent at 7.5 mg/kg every 12 hours (maximum 400 mg/dose) 1

Topical Formulations

Otic Solution (0.3%)

• Adults and children ≥12 years: 10 drops in affected ear(s) once daily for 7 days 3, 4
• Children 6 months to <13 years: 5 drops in affected ear(s) once daily for 7 days 4
• Highly effective for otitis externa with clinical cure rates of >80% in adults and >95% in children 3

Important Precautions

1. Drug interactions: Avoid concurrent administration with:

   • Antacids containing calcium, magnesium, or aluminum
   • Sucralfate
   • Divalent or trivalent cations (e.g., iron)
   • Multivitamins containing zinc
   • Didanosine
   • These should not be taken within 2 hours before or after ofloxacin 2

2. Monitoring:

   • Watch for adverse effects including gastrointestinal disturbances, dizziness, and photosensitivity
   • Most common adverse events with oral therapy include nausea, headache, and insomnia 5
   • With otic solution, most common side effects are bitter taste (5%) and pruritus (2%) 3

3. Pediatric caution:

   • Long-term use in children and adolescents requires careful consideration due to potential effects on bone and cartilage growth 1
   • Use in pediatric patients should generally be limited to situations where benefits clearly outweigh risks

Clinical Pearls

• Ofloxacin suspension for oral liquid administration is not available in the United States 1
• For pediatric patients requiring liquid formulation, consider alternative antibiotics or consult with a pharmacist about compounding options
• Ofloxacin otic solution is the first ototopical agent approved for use in patients with non-intact tympanic membranes 3
• Once-daily dosing of ofloxacin otic solution for 7 days shows excellent compliance (98%) compared to more frequent dosing regimens 4