Fluoroquinolones

Fluoroquinolones:

Ciprofloxacin (Cipro ®)

Dosing (Adults):
Usual:
(Oral): 250- 750mg q12h.
(IV): 200-400 mg IV q12h.
[Febrile neutropenia]: 400 mg IV q8h.

Bone/joint infections:
Oral: 500-750 mg twice daily for 4-6 weeks
I.V.: Mild/moderate: 400 mg every 12 hours for 4-6 weeks.
Severe/complicated: 400 mg every 8 hours for 4-6 weeks.

Chancroid (CDC guidelines): Oral: 500 mg twice daily for 3 days.

Long-term management of cirrhosis: Numerous studies demonstrate that the risk of serious bacterial infections can be reduced through antibiotic prophylaxis, either long term in patients with refractory ascites or short term in patients hospitalized with variceal hemorrhage. The best-studied prophylactic regimens are once-daily administration of 400 mg norfloxacin or Bactrim. Once-weekly administration of 750 mg of ciprofloxacin also is effective.

Nosocomial pneumonia: I.V.: 400 mg every 8 hours for 10-14 days

Prostatitis (chronic, bacterial): Oral: 500 mg every 12 hours for 28 days

Sinusitis (acute): Oral: 500 mg every 12 hours for 10 days

Renal Dosing:
[CRCL >30 ]: no changes .
[5-30 ]: (IV): 200-400mg q18-24h or give 200mg q12h. (Oral): 250 q12h or, 250-500mg q18 to 24 hours.

Hemodialysis: (IV): 200-400mg q24h or 200mg q12h. Schedule dose after dialysis on dialysis days. (Oral): 250mg q12h or 250-500mg q24h. Schedule dose after dialysis on dialysis days.

Gatifloxacin (Tequin ®)

Dosing: 400 mg po/IV qd
Renal Dosing:
[CRCL >40]: No changes.
[<40 ]: 400mg x 1, then 200mg qd.
Hemodialysis: 400 mg x 1, then 200mg qd. (On dialysis days, schedule dose after dialysis.).
PD: 400 mg x 1, then 200mg qd

Levofloxacin (Levaquin ®)

Dosing (Adults): 250 to 500 mg po/IV q24h.
Complicated skin/structure: 750 mg q24h.

Renal Dosing:
[CRCL >50] No change.
[20-49]: 500 x 1, then 250mg q24h. Complicated skin/structure: 750 mg x 1, then 750mg q48h.
[10-19]: 500mg x 1, 250mg q48h. Complicated skin/structure: 750 mg x 1, then 500mg q48h.
[<10] same as above.
Hemodialysis or PD: 500mg x 1, 250mg q48h. Complicated skin/structure: 750 mg x 1, then 500mg q48h. On dialysis days, schedule dose after dialysis.

Moxifloxacin (Avelox ®)

Dosing (Adults): 400 mg orally or IV q24h.

Acute bacterial sinusitis: Oral, I.V.: 400 mg every 24 hours for 10 days.
Chronic bronchitis, acute bacterial exacerbation: Oral, I.V.: 400 mg every 24 hours for 5 days. Note: Avelox® ABC Pack™ (Avelox® Bronchitis Course) contains five tablets of 400 mg each.
Intra-abdominal infections, complicated: Oral, I.V.: 400 mg every 24 hours for 5-14 days (initiate with I.V.).
Legionella(unlabeled use): Oral, I.V.: 400 mg every 24 hours for 10-21 days.
Pneumonia, community-acquired (including MDRSP): Oral, I.V.: 400 mg every 24 hours for 7-14 days.
Skin and skin structure infections: Oral, I.V.:
Complicated: 400 mg every 24 hours for 7-21 days
Uncomplicated: 400 mg every 24 hours for 7 days

Renal Dosing: No adjustment necessary. Hemo: No specific guidelines available.

Supplied: Tablet: 400mg. Avelox® ABC Pack: contains 5 unit dose 400mg tablets. IV (premixed): 400mg/250 ml NS. Ophthalmic soln ( Vigamox ®): 0.5% (3 ml).

Similar to other new-generation fluoroquinolones, such as grepafloxacin, levofloxacin, and trovafloxacin, moxifloxacin exhibits improved activity against pneumococci (S. pneumoniae) and other clinically relevant respiratory pathogens (eg, Haemophilus influenzae, Chlamydia, Mycoplasma), suggesting that it has a role in the treatment of ambulatory community-acquired pneumonia, sinusitis, and acute exacerbations of chronic bronchitis, particularly in older patients with underlying disease and those with resistance to other agents. Until direct comparative data are available, selection of one of these drugs over the other will be guided by mainly by cost. The overall in vitro activity of moxifloxacin is similar to that of trovafloxacin (Woodcock et al, 1997); (Barman et al, 1999). Compared to ciprofloxacin, moxifloxacin is more active against gram-positive organisms and anaerobes, but less active against the Enterobacteriaceae and Pseudomonas spp. Dave's Note: Not indicated for tx of UTI.

Norfloxacin (Noroxin ®)

Dosing (Adults): 400 mg po q12h.
Renal Dosing:
[CRCL > 30]: normal dose. [<30]: 400 mg q24h. Hemodialysis: 400 mg q24h.

Ofloxacin (Floxin ®)

Dosing (Adults): 200-400 mg po or IV q12h.

Renal Dosing:
[> 50 ml/min]: no changes.
[20-50]: 200-400mg q24h.
[<20]: 100-200mg q24h (1/2 of usual dose q24h.).
Hemodialysis: Manufacturer states: For CRCL <20 ml/min give 50% of usual dose q24h. No specific info for hemodialysis.

Disclaimer

Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.

David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.

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