ofloxacin


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ofloxacin

 [o-flok´sah-sin]
a broad-spectrum quinoloneantibacterial agent with actions similar to those of norfloxacin, effective against a wide variety of aerobic gram-negative and gram-positive organisms; administered orally in the treatment of prostatitis, sexually transmitted diseases, and infections of the lower respiratory tract, urinary tract, and skin and soft tissues, and applied topically in the treatment of bacterial corneal ulcers and ear infections.

ofloxacin

Exocin (UK), Floxin, Ocuflox, Tarivid (UK)

Pharmacologic class: Fluoroquinolone

Therapeutic class: Anti-infective

Pregnancy risk category C

FDA Box Warning

• Fluoroquinolones for systemic use are associated with an increased risk of tendinitis and tendon rupture in all ages. This risk is further increased in patients usually over age 60, with concomitant use of corticosteroids, and in kidney, heart, and lung transplant recipients.

• Drug may exacerbate muscle weakness in patients with myasthenia gravis. Avoid use in patients with known history of myasthenia gravis.

Action

Inhibits bacterial DNA synthesis by inhibiting DNA gyrase in susceptible bacteria

Availability

Ophthalmic solution: 3 mg/ml (0.3%)

Otic solution: 0.3%

Tablets: 200 mg, 300 mg, 400 mg

Indications and dosages

Prostatitis caused by Escherichia coli

Adults: 300 mg P.O. q 12 hours for 6 weeks

Complicated urinary tract infections caused by E. coli, Klebsiella pneumoniae, or Proteus mirabilis

Adults: 200 mg P.O. q 12 hours for 10 days

Uncomplicated cystitis caused by E. coli or K. pneumoniae

Adults: 200 mg P.O. q 12 hours for 3 days

Acute uncomplicated urethral and cervical gonorrhea

Adults: 400 mg P.O. as a single dose

Nongonococcal cervicitis or urethritis caused by Chlamydia trachomatis; mixed infections of cervix or urethra caused by C. trachomatis or Neisseria gonorrhoeae

Adults: 300 mg P.O. q 12 hours for 7 days

Acute bacterial exacerbation of chronic bronchitis, community-acquired pneumonia, and uncomplicated skin and skin-structure infections caused by susceptible organisms

Adults: 400 mg P.O. q 12 hours for 10 days

Acute pelvic inflammatory disease

Adults: 400 mg P.O. q 12 hours for 10 to 14 days

Bacterial conjunctivitis

Adults and children ages 1 and older: One to two drops of ophthalmic solution in affected eye q 2 to 4 hours on days 1 and 2; then one to two drops q.i.d. on days 3 through 7

Corneal ulcers

Adults: One to two drops of ophthalmic solution in affected eye q 30 minutes while awake on days 1 and 2, then one to two drops q hour while awake on days 3 to 7, then one to two drops q.i.d. while awake on days 7 to 9

Otitis externa

Adults and children ages 13 and older: 10 drops of otic solution into affected ear daily for 7 days

Chronic suppurative otitis media with perforated tympanic membrane

Adults and children ages 12 and older: 10 drops of otic solution into affected ear b.i.d. for 14 days

Dosage adjustment

• Renal impairment
• Severe hepatic impairment

Contraindications

• Hypersensitivity to drug or other fluoroquinolones

Precautions

Use cautiously in:
• underlying CNS disease, renal impairment, cirrhosis, bradycardia, acute myocardial ischemia
• known history of myasthenia gravis (avoid use)
• history of tendinitis or tendon rupture with fluoroquinolone use
• dialysis patients
• elderly patients
• pregnant or breastfeeding patients (safety not established except in postex-posure inhalation or cutaneous anthrax).
• children younger than age 18 (except in postexposure inhalation or cutaneous anthrax and in ophthalmic and otic use).

Administration

• Don't give zinc- or iron-containing drugs within 2 hours of ofloxacin.

Adverse reactions

CNS: dizziness, drowsiness, headache, light-headedness, insomnia, acute psychoses, agitation, confusion, tremors, hallucinations, increased intracranial pressure, seizures

CV: chest pain, vasodilation

GI: nausea, diarrhea, constipation, abdominal pain, pseudomembranous colitis

GU: interstitial cystitis, vaginitis

Hematologic: eosinophilia, leukopenia

Musculoskeletal: tendinitis, tendon rupture, joint pain, back pain

Skin: rash, photosensitivity, phototoxicity, Stevens-Johnson syndrome

Other: altered taste, superinfection, myasthenia gravis exacerbation

Interactions

Drug-drug.Amiodarone, bepridil, disopyramide, erythromycin, pentamidine, phenothiazines, pimozide, procainamide, quinidine, sotalol, tricyclic antidepressants: increased risk of serious adverse cardiovascular reactions

Antacids, bismuth subsalicylate, iron or zinc salts, sucralfate: decreased ofloxacin absorption

Corticosteroids: increased risk of tendon rupture

Probenecid: decreased renal elimination of ofloxacin

Theophylline: increased theophylline blood level and possible toxicity

Warfarin: increased warfarin effects

Drug-diagnostic tests.Alanine aminotransferase, aspartate aminotransferase, platelets: increased levels

Hemoglobin, hematocrit: decreased values

Drug-food.Milk or yogurt (consumed alone), tube feedings: impaired drug absorption

Drug-herbs.Fennel: decreased drug absorption

Dong quai, St. John's wort: phototoxicity

Drug-behaviors.Sun exposure: phototoxicity

Patient monitoring

• Assess patient for signs and symptoms of superinfection.
• Inspect for rash. Check for signs and symptoms of hypersensitivity reaction.

Watch for fever with diarrhea; diarrhea containing pus; or severe, persistent diarrhea; and tendinitis or tendon rupture.
• Evaluate neurologic status closely.

Patient teaching

• Encourage patient to maintain fluid intake of at least 1,500 ml daily to prevent crystalluria.
• Inform patient being treated for gonorrhea that partners must be treated.

Tell patient to immediately report fever and diarrhea, especially if stool contains blood, pus, mucus. Caution him not to treat diarrhea without consulting prescriber.

Instruct patient to stop taking drug and immediately report rash or tendon pain or inflammation.
• Instruct patient not to take iron- or zinc-containing drugs or antacids within 2 hours of ofloxacin.
• Teach patient ways to counteract photosensitivity, such as by wearing sunglasses and avoiding excessive exposure to bright light.
• Teach patient how to use eye or ear drops. Caution him not to touch dropper tip to any surface (including eye or ear).
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.

ofloxacin

/oflox·a·cin/ (o-flok´sah-sin) an antibacterial agent effective against a wide variety of gram-negative and gram-positive aerobic organisms.

ofloxacin

(ə-flŏk′sə-sĭn)
n.
An antibiotic of the fluoroquinolone class, C18H20FN3O4, used to treat various infections, especially of the urinary tract, urethra, and skin.

ofloxacin

[oflak′səsin]
a fluoroquinolone antibiotic.
indications It is used to treat lower respiratory tract infections, genitourinary infections, skin and skin structure infections, and conjunctivitis.
contraindication A known hypersensitivity to quinolones prohibits its use.
adverse effects Among the most common adverse effects are dizziness, headache, fatigue, somnolence, diarrhea, nausea, and vomiting.

ofloxacin

Floxin®, Levaquin®Antibiotics A broad-spectrum (fluoro)quinolone used for GNR Indications Bacterial skin infections, lower respiratory, urinary, prostate infections, STDs, PID, otitis externa, chronic suppurative otitis media, and acute otitis media in Pts with tympanostomy tubes. See Fluoroquinolone.

ofloxacin

An antibacterial drug. Brand names are Exocin for an eye drop preparation and Tarivid to be taken by mouth for general infections. The drug is on the WHO official list.

antibiotic 

1. Pertaining to the ability to destroy or inhibit other living organisms.
2. A substance derived from a mould or bacterium, or produced synthetically, that destroys (bactericidal) or inhibits the growth (bacteriostatic) of other microorganisms and is thus used to treat infections. Some substances have a narrow spectrum of activity whereas others act against a wide range of both gram-positive and gram-negative organisms (broad-spectrum antibiotics). Antibiotics can be classified into several groups according to their mode of action on or within bacteria: (1) Drugs inhibiting bacterial cell wall synthesis, such as bacitracin, vancomycin and the β-lactams based agents (e.g. penicillin, cephalosporins (e.g. ceftazidime, ceftriaxone, cefuroxime). (2) Drugs affecting the bacterial cytoplasmic membrane, such as polymyxin B sulfate and gramicidin. (3) Drugs inhibiting bacterial protein synthesis, such as aminoglycosides (e.g. amikacin sulfate, framycetin sulfate, gentamicin, neomycin sulfate and tobramycin), tetracyclines, macrolides (e.g. erythromycin and azithromycin) and chloramphenicol. (4) Drugs inhibiting the intermediate metabolism of bacteria, such as sulfonamides (e.g. sulfacetamide sodium) and trimethoprim. (5) Drugs inhibiting bacterial DNA synthesis, such as nalixidic acid and fluoroquinolones (e.g. ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin and ofloxacin). (6) Other antibiotics such as fusidic acid, the diamidines, such as propamidine isethionate and dibrompropamidine. Syn. antibacterial. See antiinflammatory drug; fusidic acid.

ofloxacin (ōflok´səsin),

n brand names: Floxin, Floxin IV;
drug class: fluoroquinolone antiinfective;
action: broad-spectrum bactericidal agent that inhibits the enzyme DNA-gyrase needed for replication of DNA;
uses: treatment of lower respiratory tract infections, genitourinary infections, skin and skin structure infections.

ofloxacin (optic),

n brand name: Ocuflox;
drug class: fluoroquinolone antiinfective, topical;
action: broad-spectrum bactericidal agent that inhibits the enzyme DNA-gyrase needed for replication of DNA;
uses: treatment of bacterial conjunctivitis caused by susceptible organisms.

ofloxacin

a fluoroquinolone antibiotic, similar to ciprofloxacin.
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