1. Dosage
1.1. Adults
Maximum recommended adult daily doses for fluoroquinolones are summarized in Table 1. Prescribed dosages exceeding these recommendations will be reviewed.
| Drug Name | Dosage Form/Strength | Treatment Indication | Maximum Recommended Dosage |
|---|---|---|---|
| ciprofloxacin (Cipro®, generics) | immediate-release (IR)#: 100 mg, 250 mg, 500 mg, 750 mg tablets; 250 mg/5 mL, 500 mg/5 mL suspension | acute sinusitis | 500 mg twice daily |
| bone and joint infections | 750 mg twice daily | ||
| chronic bacterial prostatitis | 500 mg twice daily | ||
| complicated intra-abdominal infections (in combination with metronidazole) | 500 mg twice daily | ||
| complicated, uncomplicated skin/skin structure infections | 750 mg twice daily | ||
| infectious diarrhea | 500 mg twice daily | ||
| inhalational anthrax (post-exposure) | 500 mg twice daily | ||
| lower respiratory tract infections | 750 mg twice daily | ||
| moderate, complicated urinary tract infection (UTI) | 500 mg twice daily | ||
| plague | 1500 mg/day | ||
| typhoid fever | 500 mg twice daily | ||
| uncomplicated cervical, urethral gonococcal infections* | 250 mg as single dose | ||
| Uncomplicated UTI | 250 mg twice daily | ||
| ciprofloxacin (Cipro® XR, generics) | extended-release (ER)#: 500 mg, 1000 mg tablets | acute uncomplicated pyelonephritis | 1000 mg/day |
| complicated UTI | 1000 mg/day | ||
| uncomplicated UTI | 500 mg/day | ||
| delafloxacin (Baxdela®) | 450 mg tablets | acute bacterial skin/skin structure infections | 450 mg twice daily |
| community acquired bacterial pneumonia (CABP) | 450 mg twice daily | ||
| gemifloxacin (Factive®) | 320 mg tablets | chronic bronchitis (acute bacterial exacerbation) | 320 mg daily |
| Community acquired pneumonia (CAP) | 320 mg daily | ||
| levofloxacin (Levaquin®, generics) | 250 mg, 500 mg, 750 mg tablets, 25 mg/mL solution | acute bacterial sinusitis | 750 mg once daily |
| acute pyelonephritis | 750 mg once daily | ||
| chronic bacterial prostatitis | 500 mg once daily | ||
| chronic bronchitis (acute bacterial exacerbation) | 500 mg once daily | ||
| CAP | 750 mg once daily | ||
| complicated skin/skin structure infections | 750 mg once daily | ||
| inhalational anthrax | 500 mg once daily | ||
| mild/moderate complicated UTI | 750 mg once daily | ||
| nosocomial pneumonia | 750 mg/day | ||
| plague or plague prophylaxis | 500 mg once daily | ||
| uncomplicated skin/skin structure infections | 500 mg once daily | ||
| uncomplicated UTI | 250 mg once daily | ||
| moxifloxacin (Avelox®, generics) | 400 mg tablets | acute bacterial sinusitis | 400 mg once/day |
| chronic bronchitis (acute bacterial exacerbation) | 400 mg once/day | ||
| CAP | 400 mg once/day | ||
| complicated intra-abdominal infections | 400 mg once/day | ||
| complicated skin/skin structure infections | 400 mg once/day | ||
| plague or plague prophylaxis | 400 mg once/day | ||
| uncomplicated skin/skin structure infections | 400 mg once/day | ||
| ofloxacin (generics) | 200 mg, 300 mg, 400 mg tablets | acute pelvic inflammatory disease (PID)^ | 400 mg twice daily |
| acute, uncomplicated urethral, cervical gonorrhea* | 400 mg as single dose | ||
| chronic bronchitis (acute bacterial exacerbation) | 400 mg twice daily | ||
| CAP | 400 mg twice daily | ||
| complicated UTI | 200 mg twice daily | ||
| mixed infection of urethra, cervix due to C. trachomatis and N. gonorrhoeae* | 300 mg twice daily | ||
| nongonococcal cervicitis/urethritis due to Chlamydia trachomatis | 300 mg twice daily | ||
| prostatitis due to E. coli | 300 mg twice daily | ||
| uncomplicated cystitis due to E. coli or K. pneumoniae | 200 mg twice daily | ||
| uncomplicated cystitis due to other organisms | 200 mg twice daily | ||
| uncomplicated skin and skin structure infections | 400 mg twice daily |
Legend:
- # ciprofloxacin immediate-release and extended-release tablets are not interchangeable
- * CDC no longer recommends fluoroquinolones for treatment of infections due to N. gonorrhoeae
- ^ CDC no longer recommends fluoroquinolones for treating PID; may be considered in combination with metronidazole if parenteral therapy not feasible
1.2. Pediatrics
Fluoroquinolones are not drugs of choice in pediatric patients due to an increased incidence of musculoskeletal adverse reactions, including arthralgias and events related to surrounding joints and tissues10. However, ciprofloxacin and levofloxacin have been evaluated for use in pediatric patients and are FDA-approved for use in select circumstances. Recommended dosage guidelines for fluoroquinolones in pediatric patients are summarized in Table 2.
| Drug Name | Treatment Indication | Maximum Recommended Dosage |
|---|---|---|
| ciprofloxacin | complicated urinary tract infection (UTI) or pyelonephritis | 10-20 mg/kg orally every 12 hours (not to exceed 750 mg/dose) |
| inhalational anthrax (postexposure prophylaxis) | 15 mg/kg orally every 12 hours (not to exceed 500 mg/dose) | |
| plague | 15 mg/kg orally every 8-12 hours (not to exceed 500 mg/dose) | |
| levofloxacin | inhalational anthrax (postexposure prophylaxis) |
Greater than or equal to 6 months of age and less than 50 kg: 8 mg/kg orally every 12 hours (not to exceed 250 mg/dose) Greater than or equal to 6 months of age and greater than 50 kg: 500 mg orally once daily |
| plague |
Greater than or equal to 6 months of age and less than 50 kg: 8 mg/kg orally every 12 hours (not to exceed 250 mg/dose) Greater than or equal to 6 months of age and greater than 50 kg: 500 mg orally once daily |