What is the dosage and treatment protocol for Ofloxacin (fluoroquinolone antibiotic)?

Ofloxacin Dosage and Treatment Protocol

Ofloxacin should be dosed at 200-400 mg orally every 12 hours, with specific dosages varying by indication as outlined in the FDA-approved regimens. 1

Adult Dosing Regimens by Indication

Respiratory Tract Infections

• Acute bacterial exacerbation of chronic bronchitis: 400 mg orally every 12 hours for 10 days (800 mg daily) 1
• Community-acquired pneumonia: 400 mg orally every 12 hours for 10 days (800 mg daily) 1

Skin and Skin Structure Infections

• Uncomplicated skin and skin structure infections: 400 mg orally every 12 hours for 10 days (800 mg daily) 1
• For difficult skin and skin structure infections, especially in hospitalized patients or those with diabetes, the same dosage has shown 87% clinical cure or improvement 2

Sexually Transmitted Infections

• Acute, uncomplicated urethral and cervical gonorrhea: 400 mg orally as a single dose 1
• Nongonococcal cervicitis/urethritis due to C. trachomatis: 300 mg orally every 12 hours for 7 days (600 mg daily) 1, 3
• Mixed infection of urethra and cervix due to C. trachomatis and N. gonorrhoeae: 300 mg orally every 12 hours for 7 days (600 mg daily) 1
• Acute pelvic inflammatory disease: 400 mg orally every 12 hours for 10-14 days (800 mg daily) 1
• Epididymitis (alternative regimen): 300 mg orally twice daily for 10 days 3

Urinary Tract Infections

• Uncomplicated cystitis due to E. coli or K. pneumoniae: 200 mg orally every 12 hours for 3 days (400 mg daily) 1
• Uncomplicated cystitis due to other approved pathogens: 200 mg orally every 12 hours for 7 days (400 mg daily) 1
• Complicated UTIs: 200 mg orally every 12 hours for 10 days (400 mg daily) 1
• Prostatitis due to E. coli: 300 mg orally every 12 hours for 6 weeks (600 mg daily) 1

Otic Formulation

• For otitis externa: 5 drops (children 6 months to 12 years) or 10 drops (≥13 years) of 0.3% solution once daily for 7 days 4, 5

Special Population Considerations

Pediatric Patients

• Ofloxacin is contraindicated for persons ≤17 years of age for most indications 3
• For plague prophylaxis in children (if alternatives exhausted): 7.5 mg/kg orally every 12 hours (maximum 400 mg/dose) 3

Renal Impairment

• For creatinine clearance 20-50 mL/min: usual recommended unit dose every 24 hours 1
• For creatinine clearance <20 mL/min: half the usual recommended unit dose every 24 hours 1

Hepatic Impairment

• For severe liver function disorders (cirrhosis with or without ascites): maximum dose should not exceed 400 mg per day 1

Administration Considerations

• Antacids containing calcium, magnesium, or aluminum; sucralfate; divalent or trivalent cations such as iron; multivitamins containing zinc; or didanosine should not be taken within 2 hours before or after taking ofloxacin 1
• For optimal compliance, medications should be dispensed on site when possible, with the first dose directly observed 3
• Patients should abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a multi-day regimen to minimize further transmission of infection 3

Clinical Efficacy Notes

• Ofloxacin has shown high efficacy rates in respiratory infections: 98% in lower respiratory tract infections, 83% in pneumonias, and 87-95% in acute exacerbations of chronic bronchitis 6
• Bacterial eradication rates in respiratory infections range from 70% for S. pneumoniae to 88.5% for H. influenzae 6
• In skin infections, ofloxacin achieved clinical cure in 67% and improvement in 20% of difficult-to-treat cases 2

Common Pitfalls and Caveats

• Resistance patterns should be monitored, as some pathogens (particularly Streptococci and anaerobes) have variable susceptibility to fluoroquinolones 3
• For gonorrhea treatment, if chlamydial infection is not ruled out, consider adding azithromycin 1g orally in a single dose or doxycycline 100 mg orally twice daily for 7 days 7
• Patients with sexually transmitted infections should be instructed to refer sex partners for evaluation and treatment if contact occurred within 30 days of symptom onset 3
• Failure to improve within 3 days for conditions like epididymitis requires re-evaluation of both diagnosis and therapy 3