Ofloxacin
General
- Type: Fluroquinolones
- 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
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
- Adult
- Hepatic Dosing
- Adult
- cirrhosis: max 400mg/24h
- Pediatric
- specific adjustment not defined though adjustment may be required
- Adult
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
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]
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
- Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161 DOI: 10.1177/0194599813517659 PDF
- 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.
- Sanford Guide to Antimicrobial Therapy 2014
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