What is the recommended dose of ofloxacin (fluoroquinolone antibiotic) for a 14-year-old girl weighing 44 kg with confirmed typhoid fever?

Ofloxacin Dosage for Typhoid Fever in a 14-year-old Girl Weighing 44 kg

The recommended dose of ofloxacin for a 14-year-old girl weighing 44 kg with confirmed typhoid fever is 7.5 mg/kg every 12 hours orally (330 mg per dose, maximum 400 mg/dose) for 7-10 days. 1, 2

Dosage Calculation

• Weight: 44 kg
• Recommended pediatric dose: 7.5 mg/kg every 12 hours 2
• Calculation: 44 kg × 7.5 mg/kg = 330 mg per dose
• Maximum dose: 400 mg per dose 2
• Frequency: Every 12 hours
• Duration: 7-10 days 2

Evidence-Based Rationale

The Centers for Disease Control and Prevention (CDC) specifically recommends ofloxacin at 7.5 mg/kg every 12 hours orally (maximum 400 mg/dose) for children with typhoid fever 2. This patient falls below the 45 kg threshold that would qualify her for adult dosing, so the weight-based pediatric dosing is appropriate.

Special Considerations

1. Safety in Pediatric Population:

   • While fluoroquinolones like ofloxacin have concerns about effects on bone and cartilage growth in children, their use is justified in typhoid fever where benefits outweigh risks 1
   • The patient at 14 years old is approaching skeletal maturity, which reduces these concerns

2. Efficacy:

   • Ofloxacin has demonstrated excellent efficacy against typhoid fever, including multidrug-resistant strains 3
   • Studies show significantly faster fever clearance and bacterial eradication with ofloxacin compared to alternatives like co-trimoxazole 3

3. Duration of Treatment:

   • The WHO recommends 7-10 days of treatment for typhoid fever 2
   • Shorter courses (3-5 days) have been studied in adults but are not recommended for pediatric patients without specialist consultation 4, 5

Administration Guidelines

• Administer orally twice daily
• Can be taken with or without food (though taking with food may reduce gastrointestinal side effects)
• Complete the full course of antibiotics even if symptoms improve before completion

Monitoring

• Monitor for clinical improvement (fever resolution typically within 3-5 days)
• Watch for potential adverse effects:
  • Gastrointestinal: nausea, diarrhea
  • Neurological: dizziness, headache
  • Dermatological: rash, photosensitivity

Important Caveats

• Ofloxacin suspension is not commercially available in the United States; tablets will need to be used 2
• If the patient cannot swallow tablets, consultation with a pharmacist for appropriate administration options is necessary
• If the patient has renal impairment, dose adjustment would be required
• Avoid concurrent administration with antacids, sucralfate, or products containing divalent or trivalent cations (calcium, iron, zinc) as they can reduce absorption

This recommendation balances the need for effective treatment of typhoid fever with appropriate consideration of the patient's age and weight, following established guidelines for pediatric dosing of ofloxacin.