Ofloxacin: Difference between revisions

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==General==
==General==
*Type: [[Fluroquinolones]]
*Type: [[Is Generation:: 2nd generation]] [[Is DrugClass::Fluoroquinolones]]
*Dosage Forms:
*Dosage Forms: 200,300,400, topical/otic
*Common Trade Names:  
*Common Trade Names: Floxin, Floxin Otic


==Adult Dosing==
==Adult Dosing==
===Infections, bacterial===
*200-400mg PO q12h
===Infections, [[chlamydial]]===
*300mg PO q12h x 7d
===[[Urethritis]], nongonococcal===
*300mg PO q12h x 7d
===[[Epididymitis]]===
*300mg PO q12h x 10d
===[[Typhoid fever]]===
*400mg PO q12h x 7-14d
===[[Otitis Externa]]===
*5 drops in affected ear BID x 7 days<ref name="CPGENT2014">Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161 DOI: 10.1177/0194599813517659 [http://www.aepap.org/sites/default/files/otitis_externa_guia2014-rosenfeld-161-8_0.pdf PDF]</ref>
**Safe with perforations


==Pediatric Dosing==
==Pediatric Dosing==
===[[PID]]===
*>12yrs: 400mg PO BID x 14d
===[[Typhoid fever]]===
*20mg/kg BID x 10d, max 400mg/dose
===[[Otitis Externa]]===
*6mo-13 yo: 5 drops in affected ear BQD x 7 days
*>13 yo: 5 drops in affected ear BID x 7 days<ref name="CPGENT2014">Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161 DOI: 10.1177/0194599813517659 [http://www.aepap.org/sites/default/files/otitis_externa_guia2014-rosenfeld-161-8_0.pdf PDF]</ref>


==Special Populations==
==Special Populations==
*Pregnancy:
*Pregnancy: C (risk cannot be excluded)
*Lactation:
*Lactation: probably safe
*Renal Dosing
*Renal Dosing
**Adult
**Adult
***GFR 20-50: give q24h
***GFR < 20: give usual dose x1, then decrease dose 50% q24h
***HD: give 100-200mg after dialysis
**Pediatric
**Pediatric
***specific adjustment not defined though adjustment may be required
*Hepatic Dosing
*Hepatic Dosing
**Adult
**Adult
***cirrhosis: max 400mg/24h
**Pediatric
**Pediatric
***specific adjustment not defined though adjustment may be required


==Contraindications==
==Contraindications==
*Allergy to class/drug
*Allergy to class/drug
*myasthenia gravis
*prolonged QT
*history of torsades de pointes
*caution if ventricular arrhythmias, bradycardia, recent MI
*caution if CHF, patient > 60
*caution if history of renal, heart, lung transplant
*caution in seizure disorder
*caution in DM


==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*[[Anaphylaxis]]
*[[Seizure]]
*Phototoxicity
*Superinfection
*Increased ICP
*Toxic psychosis
*[[Vasculitis]]
*Serum sickness
*Hypersensitivity pneumonitis
*[[QT prolongation]]
*[[Torsades de pointes]]
*Peripheral [[neuropathy]]
*Hepatotoxicity
*Nephrotoxicity
*Crystalluria
*Myelosuppression
*Blood dyscrasias
*Tendonitis or tendon rupture (black box warning) - increased risk in age >60, immunosuppressed, corticosteroid use
*Myasthenia exacerbation
*Severe Hypoglycemia <ref>FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions. US Food and Drug Administration. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm612995.htm. Updated July 10, 2018. Accessed Oct 22, 2018.</ref>
*mental health effects


===Common===
===Common===
*[[Nausea]]/[[vomiting]]
*[[Diarrhea]]
*Abnormal ECG
*[[Headache]]
*[[Dyspepsia]]
*[[Dizziness]]
*[[Vaginitis]]
*Insomnia
*Photosensitivity
*[[Pruritus]]
*Anxiety
*Agitation
*Tendinitis
*Elevated LFTs


==Pharmacology==
==Pharmacology==
*Half-life:  
*Half-life: 4-8h, if GFR < 10 then 17-28h
*Metabolism:  
*Metabolism: liver minimally
*Excretion:  
*Excretion: urine primarily (70-90% unchanged), bile/feces (4-8%)
*Mechanism of Action:
*Mechanism of Action: inhibits DNA gyrase and topoisomerase IV


==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
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*[[Antibiotics (Main)]]
*[[Antibiotics (Main)]]


==Source==
==References==
 
<references/>
<references/>
[[Category:Drugs]]
[[Category:Pharmacology]]
[[Category:ID]]

Latest revision as of 17:07, 18 July 2025

General

  • Type: 2nd generation Fluoroquinolones
  • Dosage Forms: 200,300,400, topical/otic
  • Common Trade Names: Floxin, Floxin Otic

Adult Dosing

Infections, bacterial

  • 200-400mg PO q12h

Infections, chlamydial

  • 300mg PO q12h x 7d

Urethritis, nongonococcal

  • 300mg PO q12h x 7d

Epididymitis

  • 300mg PO q12h x 10d

Typhoid fever

  • 400mg PO q12h x 7-14d


Otitis Externa

  • 5 drops in affected ear BID x 7 days[1]
    • Safe with perforations

Pediatric Dosing

PID

  • >12yrs: 400mg PO BID x 14d

Typhoid fever

  • 20mg/kg BID x 10d, max 400mg/dose

Otitis Externa

  • 6mo-13 yo: 5 drops in affected ear BQD x 7 days
  • >13 yo: 5 drops in affected ear BID x 7 days[1]

Special Populations

  • Pregnancy: C (risk cannot be excluded)
  • Lactation: probably safe
  • Renal Dosing
    • Adult
      • GFR 20-50: give q24h
      • GFR < 20: give usual dose x1, then decrease dose 50% q24h
      • HD: give 100-200mg after dialysis
    • Pediatric
      • specific adjustment not defined though adjustment may be required
  • Hepatic Dosing
    • Adult
      • cirrhosis: max 400mg/24h
    • Pediatric
      • specific adjustment not defined though adjustment may be required

Contraindications

  • Allergy to class/drug
  • myasthenia gravis
  • prolonged QT
  • history of torsades de pointes
  • caution if ventricular arrhythmias, bradycardia, recent MI
  • caution if CHF, patient > 60
  • caution if history of renal, heart, lung transplant
  • caution in seizure disorder
  • caution in DM

Adverse Reactions

Serious

  • Anaphylaxis
  • Seizure
  • Phototoxicity
  • Superinfection
  • Increased ICP
  • Toxic psychosis
  • Vasculitis
  • Serum sickness
  • Hypersensitivity pneumonitis
  • QT prolongation
  • Torsades de pointes
  • Peripheral neuropathy
  • Hepatotoxicity
  • Nephrotoxicity
  • Crystalluria
  • Myelosuppression
  • Blood dyscrasias
  • Tendonitis or tendon rupture (black box warning) - increased risk in age >60, immunosuppressed, corticosteroid use
  • Myasthenia exacerbation
  • Severe Hypoglycemia [2]
  • mental health effects

Common

Pharmacology

  • Half-life: 4-8h, if GFR < 10 then 17-28h
  • Metabolism: liver minimally
  • Excretion: urine primarily (70-90% unchanged), bile/feces (4-8%)
  • Mechanism of Action: inhibits DNA gyrase and topoisomerase IV

Antibiotic Sensitivities[3]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G I
Strep. Pneumoniae I
Viridans strep R
Strep. anginosus gp R
Enterococcus faecalis U
Enterococcus faecium R
MSSA S
MRSA R
CA-MRSA X1
Staph. Epidermidis S
C. jeikeium R
L. monocytogenes R
Gram Negatives N. gonorrhoeae I
N. meningitidis S
Moraxella catarrhalis S
H. influenzae S
E. coli S
Klebsiella sp S
E. coli/Klebsiella ESBL+ S
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg S
Enterobacter sp, AmpC pos S
Serratia sp S
Serratia marcescens X1
Salmonella sp S
Shigella sp S
Proteus mirabilis S
Proteus vulgaris S
Providencia sp. S
Morganella sp. S
Citrobacter freundii S
Citrobacter diversus S
Citrobacter sp. S
Aeromonas sp S
Acinetobacter sp. I
Pseudomonas aeruginosa I
Burkholderia cepacia R
Stenotrophomonas maltophilia R
Yersinia enterocolitica S
Francisella tularensis X1
Brucella sp. X1
Legionella sp. S
Pasteurella multocida S
Haemophilus ducreyi X1
Vibrio vulnificus X1
Misc Chlamydophila sp S
Mycoplasm pneumoniae S
Rickettsia sp X1
Mycobacterium avium X1
Anaerobes Actinomyces I
Bacteroides fragilis R
Prevotella melaninogenica I
Clostridium difficile X1
Clostridium (not difficile) I
Fusobacterium necrophorum X1
Peptostreptococcus sp. I

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. ↑ 1.0 1.1 Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161 DOI: 10.1177/0194599813517659 PDF
  2. ↑ FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions. US Food and Drug Administration. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm612995.htm. Updated July 10, 2018. Accessed Oct 22, 2018.
  3. ↑ Sanford Guide to Antimicrobial Therapy 2014
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