Do not take fluoroquinolones if you are pregnant. Do not give fluoroquinolones to infants, children, or teenagers unless otherwise directed by your doctor. These medicines have been shown to cause bone development problems in young animals.

Fluoroquinolones should be used only to treat bacterial infections and not viral infections like the common cold.

To help clear up your infection completely, keep taking your medicine for the full time of treatment, even if you begin to feel better after a few days. If you stop taking this medicine too soon, your symptoms may return.

Fluoroquinolones are best taken with a full glass (8 ounces) of water. Several additional glasses of water should be taken every day, unless you are otherwise directed by your doctor. Drinking extra water will help to prevent some unwanted effects of ciprofloxacin and norfloxacin.

Enoxacin or norfloxacin should be taken on an empty stomach.

Ciprofloxacin, gatifloxacin, levofloxacin, lomefloxacin, moxifloxacin, ofloxacin, or sparfloxacin may be taken with meals or on an empty stomach. Ciprofloxacin should NOT be taken with dairy products or calcium-fortified juices alone, but may be taken with a meal that contains these products

This medicine works best when there is a constant amount in the blood or urine. To help keep the amount constant, do not miss any doses. Also, it is best to take the doses at evenly spaced times, day and night. For example, if you are to take two doses a day, the doses should be spaced about 12 hours apart. If this interferes with your sleep or other daily activities, or if you need help in planning the best times to take your medicine, check with your health care professional.

Dosing

The dose of fluoroquinolones will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of fluoroquinolones. Your dose may be different if you have kidney disease. If your dose is different, do not change it unless your doctor tells you to do so.

The number of tablets or amount of oral suspension that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using a fluoroquinolone.

For ciprofloxacin
• For oral dosage form (oral suspension or tablets):
  • Adults: 100 to 750 milligrams (mg) every twelve hours for three to twenty-eight days, depending on the medical problem being treated. Bone and joint infections are usually treated for at least four to six weeks. Gonorrhea is usually treated with a single oral dose of 250 mg. Inhalational anthrax is usually treated for sixty days with 500 mg every twelve hours.
  • Children up to 18 years of age: This medicine is not recommended for use in infants, children, or teenagers, except in the case of inhalational anthrax. Inhalational anthrax is usually treated for sixty days with 15 mg per kilogram (kg) (6.8 mg per pound) of body weight every twelve hours.
• For injection dosage form:
  • Adults: 200 to 400 mg every eight to twelve hours.
  • Children up to 18 years of age: This medicine is not recommended for use in infants, children, or teenagers, except in the case of inhalational anthrax. Inhalational anthrax is usually treated for sixty days with 10 mg per kg (4.5 mg per pound) of body weight every twelve hours.

For enoxacin
• For oral dosage form (tablets):
  • Adults: 200 to 400 mg every twelve hours for seven to fourteen days, depending on the medical problem being treated. Gonorrhea is usually treated with a single oral dose of 400 mg.
  • Children up to 18 years of age: This medicine is not recommended for use in infants, children, or teenagers.

For gatifloxacin
• For oral dosage form (oral suspension or tablets):
  • Adult: 200 to 400 mg every twenty four hours for seven to fourteen days, depending on the medical problems being treated. Gonorrhea and certain bladder infection are usually treated with a single oral dose of 400 mg.
  • Children up to 18 years of age: This medicine is not recommended for use in infants, children, or teenagers.
• For injection dosage form:
  • Adults: 200 to 400 mg every twenty four hours for seven to fourteen days, depending on the medical problems being treated. Gonorrhea and certain bladder infection are usually treated with a single oral dose of 400 mg.
  • Children up to 18 years of age: This medicine is not recommended for use in infants, children, or teenagers.

For levofloxacin
• For oral dosage form (tablets):
  • Adults: 250 to 750 mg once a day for seven to fourteen days, depending on the medical problem being treated.
  • Children up to 18 years of age: This medicine is not recommended for use in infants, children, or teenagers.
• For injection dosage form:
  • Adults: 250 to 750 mg, injected slowly into a vein, once a day for seven to fourteen days, depending on the medical problem being treated.
  • Children up to 18 years of age: This medicine is not recommended for use in infants, children, or teenagers.

For lomefloxacin
• For oral dosage form (tablets):
  • Adults: 400 mg once a day for three to fourteen days, depending on the medical problem being treated.
  • Children up to 18 years of age: This medicine is not recommended for use in infants, children, or teenagers.

For moxifloxacin
• For oral dosage form (tablets):
  • Adult: 400 mg once a day for five to fourteen days, depending on the medical problem being treated.
  • Children up to 18 years of age: This medicine is not recommended for use in infants, children, or teenagers.
• For injection dosage form:
  • Adult: 400 mg injected in a vein once a day for five to fourteen days, depending on the medical problem being treated.
  • Children up to 18 years of age: This medicine is not recommended for use in infants, children, or teenagers.

For norfloxacin
• For oral dosage form (tablets):
  • Adults: 400 mg every twelve hours for three to twenty-eight days, depending on the medical problem being treated. Gonorrhea is usually treated with a single oral dose of 800 mg.
  • Children up to 18 years of age: This medicine is not recommended for use in infants, children, or teenagers.

For ofloxacin
• For oral dosage form (tablets):
  • Adults: 200 to 400 mg every twelve hours for three to fourteen days, depending on the medical problem being treated. Prostatitis is usually treated for six weeks. Gonorrhea is usually treated with a single oral dose of 400 mg.
  • Children up to 18 years of age: This medicine is not recommended for use in infants, children, or teenagers.
• For injection dosage form:
  • Adults: 200 to 400 mg, injected slowly into a vein, every twelve hours for three to fourteen days, depending on the medical problem being treated. Prostatitis is usually treated for six weeks. Gonorrhea is usually treated with a single dose of 400 mg.
  • Children up to 18 years of age: This medicine is not recommended for use in infants, children, or teenagers.

For sparfloxacin
• For oral dosage form (tablets):
  • Adults: 400 mg on the first day, then 200 mg once a day for an additional nine days.
  • Children up to 18 years of age: This medicine is not recommended for use in infants, children, or teenagers.

Missed dose

If you miss a dose of this medicine, take it as soon as possible. This will help to keep a constant amount of medicine in the blood or urine. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Ciprofloxacin oral suspension may be refrigerated. However, keep this medicine from freezing.
• Gatifloxacin oral suspension may be stored in the tightly closed bottle in a refrigerator for 14 days. Shake thoroughly prior to each use.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For the fluoroquinolones, the following should be considered:

Allergies Tell your doctor if you have ever had any unusual or allergic reaction to any of the fluoroquinolones or to any related medicines such as cinoxacin (e.g., Cinobac) or nalidixic acid (e.g., NegGram). Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy Studies have not been done in humans. However, use is not recommended during pregnancy since fluoroquinolones have been reported to cause bone development problems in young animals.

Breast-feeding Some of the fluoroquinolones are known to pass into human breast milk. Since fluoroquinolones have been reported to cause bone development problems in young animals, breast-feeding is not recommended during treatment with these medicines.

Children Use is not recommended for infants or children since fluoroquinolones have been shown to cause bone development problems in young animals. However, your doctor may choose to use one of these medicines if other medicines cannot be used.

Older adults These medicines have been tested and, in effective doses, have not been shown to cause different side effects or problems in older people than they do in younger adults.

Other medicines Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking a fluoroquinolone, it is especially important that your health care professional know if you are taking any of the following:

• Aminophylline or
• Oxtriphylline (e.g., Choledyl) or
• Theophylline (e.g., Elixophyllin, Theo-Dur) Ciprofloxacin, enoxacin, and norfloxacin may increase the chance of side effects of aminophylline, oxtriphylline, or theophylline

• Amiodarone (e.g., Cordarone) or
• Astemizole (e.g., Hismanal) or
• Bepridil (e.g., Vascor) or
• Cisapride (e.g., Propulsid) or
• Disopyramide (e.g., Norpace) or
• Erythromycin (e.g., E-Mycin) or
• Pentamidine (e.g., NebuPent) or
• Phenothiazines (acetophenazine [e.g., Tindal], chlorpromazine [e.g., Ormazine, Thorazine Spansule, Thor-Prom], fluphenazine [e.g., Permitil, Prolixin], mesoridazine [e.g., Serentil], methotrimeprazine [e.g., Nozinan], pericyazine [e.g., Neuleptil], perphenazine [e.g., Trilafon], prochlorperazine [e.g., Compazine], promazine [e.g., Primazine, Sparine], thioridazine [e.g., Mellaril], trifluoperazine [e.g., Stelazine], triflupromazine [e.g., Vesprin]) or
• Procainamide (e.g., Pronestyl) or
• Quinidine (e.g., Quinidex) or
• Sotalol (e.g., Sotacor) or
• Terfenadine (e.g., Seldane) or
• Tricyclic antidepressants (amitriptyline [e.g., Elavil, Endep], amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Norpramin], doxepin [e.g., Sinequan], imipramine [e.g., Norfranil, Tipramine, Tofranil], nortriptyline [e.g., Aventyl, Pamelor], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil]) Use of these medicines with gatifloxacin, levofloxacin, moxifloxacin or sparfloxacin may cause heart problems, such as an irregular heartbeat

• Antacids, aluminum-, calcium-, and/or magnesium-containing, or
• Didanosine (e.g., Videx, ddI) or
• Iron supplements or
• Sucralfate (e.g., Carafate) Antacids, didanosine, iron, or sucralfate may keep any of the fluoroquinolones from working properly. Ciprofloxacin may be taken 2 hours before or 6 hours after these medicines. Moxifloxacin may be taken 4 hours before or 8 hours after these medicines.

• Caffeine Ciprofloxacin, enoxacin, and norfloxacin may increase the chance of side effects of caffeine; caffeine should not be taken during treatment with enoxacin

• Phenytoin (e.g., Dilantin) Ciprofloxacin may keep phenytoin from working properly

• Warfarin (e.g., Coumadin) Ciprofloxacin and norfloxacin may increase the effect of warfarin, increasing the chance of bleeding

• Brain or spinal cord disease, including hardening of the arteries in the brain or epilepsy or other seizures Fluoroquinolones may cause nervous system side effects

• Diabetes mellitus (sugar diabetes) Levofloxacin may cause changes in blood sugar, which could lead to problems in controlling blood sugar

• Diarrhea May be a sign of colon problems and taking fluoroquinolones could make this problem worse. Your doctor will want to check you before you begin taking your medicine.

• Glucose-6-phosphate dehydrogenase activity defect (problem with an enzyme that your body makes) If you have this condition and you take a fluoroquinolone, you could have problems with anemia.

• Heart disease Gatifloxacin, moxifloxacin or sparfloxacin may make this problem worse

• Kidney disease or
• Liver disease Patients with kidney disease or liver disease may have an increased chance of side effects with any of the fluoroquinolones

• Myasthenia gravis (muscle disease) This condition may become worse when taking a fluoroquinolone and cause your respiratory muscles to become weak which is life-threatening. Be sure and tell your doctor if you have this condition.

• Sensitivity of the skin to sunlight (previous) Patients taking sparfloxacin or any of the other fluoroquinolones may have an increased risk of severe reactions to sunlight

• Tendinitis (previous) Fluoroquinolones may increase the risk of tendon injury