What is the recommended dose of ofloxacin (fluoroquinolone) for children?

Ofloxacin Dosing in Children

For systemic ofloxacin use in children, administer 7.5 mg/kg every 12 hours (maximum 400 mg/dose) for general infections, or 15-20 mg/kg/day (maximum 1.0 g/day) for multidrug-resistant tuberculosis, though fluoroquinolones should be reserved for situations where first-line agents cannot be used due to resistance or intolerance. 1

Systemic (Oral/IV) Dosing by Indication

General Infections

• Standard dosing: 7.5 mg/kg every 12 hours (maximum 400 mg/dose) 1
• This applies to children ≥1 month to ≤17 years of age 1
• For children 6 months to <5 years, consider 10 mg/kg every 12 hours based on pharmacokinetic data showing faster clearance in younger children 2

Multidrug-Resistant Tuberculosis (MDR-TB)

• Recommended dose: 15-20 mg/kg/day as a single daily dose or divided into two doses (maximum 1.0 g/day) 1
• Weight-based dosing table for practical administration: 1
  • 5-6.9 kg: 150 mg daily
  • 7-9.9 kg: 200 mg daily
  • 10-13.9 kg: 300 mg daily
  • 14-19.9 kg: 400 mg daily
  • 20-29.9 kg: 600 mg daily
  • 30-39.9 kg: 800 mg daily
  • ≥40 kg: 1200 mg daily (maximum 1.0 g/day)
• Important caveat: Current pediatric dosing of 15-20 mg/kg results in significantly lower drug exposures compared to adults (mean AUC 66.7 μg·h/ml vs adult median 103 μg·h/ml), which may compromise efficacy 3
• Adult dosing applies starting at age 15 years 1

Adolescents

• Use adult dosing (500-1,000 mg daily) starting at age 15 years 4, 1
• For ages 12-14 years, continue weight-based pediatric dosing 1

Ophthalmic Dosing (Bacterial Conjunctivitis)

Children ≥1 Year

• Days 1-2: 1-2 drops of 0.3% solution in affected eye(s) every 2-4 hours 5
• Days 3-5: 1-2 drops four times daily 5
• Total treatment duration: 5-7 days 5

Critical Safety Considerations

When to Use Fluoroquinolones in Children

• Reserve for specific situations only: 4, 1
  • Multidrug-resistant tuberculosis (organisms resistant to both isoniazid and rifampin)
  • Intolerance to first-line agents
  • No safer alternatives available
• Not approved for long-term use (>several weeks) in children due to concerns about bone and cartilage growth effects 4, 1
• Most experts agree ofloxacin should be considered for children with MDR-TB despite lack of formal approval 4

Preferred Alternatives When Possible

• For community-acquired pneumonia: amoxicillin 90 mg/kg/day in 2 doses (maximum 4 g/day) 1
• For atypical pneumonia: azithromycin 10 mg/kg day 1, then 5 mg/kg/day days 2-5 1
• If a fluoroquinolone is necessary, levofloxacin is generally preferred over ofloxacin with better-established pediatric dosing 1

Important Practical Considerations

Formulation Challenges

• Ofloxacin oral suspension is not available in the United States 1
• Tablets must be crushed or split for weight-based dosing in smaller children 1

Drug Interactions

• Do not administer within 2 hours of antacids or medications containing divalent cations (calcium, magnesium, aluminum, iron), as these markedly decrease fluoroquinolone absorption 4

Monitoring Requirements

• Regular monitoring for adverse effects is recommended, particularly with prolonged use 1
• Clinical improvement should be expected within 48-72 hours for respiratory infections 6

Renal Dosing Adjustments

• Ofloxacin is 80% renally cleared 4
• Dosage adjustment recommended if creatinine clearance <50 mL/minute 4
• Not removed by hemodialysis; supplemental doses after dialysis are not necessary 4

Common Pitfalls to Avoid

• Do not use as first-line therapy for drug-susceptible infections when safer alternatives exist 4, 1
• Do not use in pregnancy due to teratogenic effects 4
• Avoid prolonged use to prevent antimicrobial resistance development 5
• Be aware that current MDR-TB dosing may be suboptimal based on pharmacokinetic data showing lower exposures than adults 3