OFLOXACIN

OFLOXACIN
(o-flox'a-cin)
Floxin, Floxin Otic, Ocuflox
Classifications: antibiotic, quinolone;
Therapeutic: antibiotic, quinolone

Prototype: Ciprofloxacin
Pregnancy Category: C

Availability

200 mg, 300 mg, 400 mg tablets; 40 mg/mL injection; 0.3% ophthalmic solution; 0.3% otic solution

Action

A fluoroquinolone antibiotic that inhibits DNa gyrase, an enzyme necessary for bacterial DNA replication and some aspects of its transcription, repair, recombination, and transposition.

Therapeutic Effect

Has a broad spectrum of activity against gram-positive and gram-negative bacteria. Most effective against gram-negative organisms including aerobic and anaerobic bacteria.

Uses

Chlamydia trachomatis infection, uncomplicated gonorrhea, prostatitis, respiratory tract infections, skin and skin structure infections, urinary tract infections due to susceptible bacteria, superficial ocular infections, pelvic inflammatory disease. Otic: otitis externa, otitis media with perforated tympanic membranes.

Unlabeled Uses

EENT infections, Helicobacter pylori infections, Salmonella gastroenteritis.

Contraindications

Hypersensitivity to ofloxacin or other quinolone antibacterial agents; tendon pain; sunlight (UV) exposure; QT prolongation; viral infection; pregnancy (category C).

Cautious Use

Renal disease; patients with a history of epilepsy, psychosis, or increased intracranial pressure, cerebrovascular disease, CNS disorders such as seizures, epilepsy, myasthenia gravis; GI disease, colitis, dehydration; syphilis; atrial fibrillation; acute MI; CVA; children and adolescents <18 y (except for otic preparation).

Route & Dosage

Uncomplicated Gonorrhea
Adult: PO 400 mg for 1 dose

Urinary Tract, Respiratory Tract, and Skin and Skin Structure Infections
Adult: PO 200–400 mg q12h x 7–10 d IV 400 mg q12h x 7 d

Prostatitis
Adult: PO 300 mg b.i.d. x 6 wk

Superficial Ocular Infections
Adult: Ophthalmic Instill 1–2 drops q2–4h for first 2 d, then q.i.d. for up to 5 additional d

Otitis Media with Perforation
Adult: Otic 10 drops (0.5 mL) q12h for 14 d
Child (≥1 y): Otic 5 drops (0.25 mL) q12h for 14 d

Otitis Externa
Adult: Otic 10 drops (0.5 mL) q12h for 7 d
Child (6 mo–13 y): Otic 5 drops (0.25 mL) q12h for 7 d

Renal Impairment
Clcr 20–50mL/min: dose should be given q24h; <20 mL/min: ? the dose q24h

Hepatic Impairment
Severe impairment: 400 mg qd

Administration

Oral
  • Do not give with meals.
  • Avoid administering mineral supplements or vitamins with iron or zinc within 2 h of drug.
  • Do not give antacids with magnesium, aluminum, or sucralfate within 4 h before or 2 h after drug.
Instillation
  • Do NOT allow tip of dropper for ocular preparation to contact any surface.
Intravenous

PREPARE: Intermittent: Withdraw the required dose from a 10 mL (40 mg/mL) or 20 mL (20 mg/mL) vial and add to 100 mL D5W, NS, D5/NS or other compatible solution. Final concentration may range from 0.4 mg/mL to 4 mg/mL.  

ADMINISTER: Intermittent: Give a single dose over at least 60 min. Avoid rapid infusion.  

INCOMPATIBILITIES Y-site: Amphotericin B cholesteryl sulfate complex, cefepime, doxorubicin liposome.

Adverse Effects (≥1%)

CNS: Headache, dizziness, insomnia, hallucinations. GI: Nausea, vomiting, diarrhea, GI discomfort. Urogenital: Pruritus, pain, irritation, burning, vaginitis, vaginal discharge, dysmenorrhea, menorrhagia, dysuria, urinary frequency. Skin: Pruritus, rash. Other: Cartilage erosion.

Diagnostic Test Interference

May cause false positive on opiate screening tests.

Interactions

Drug: Ofloxacin absorption decreased when it is administered with magnesium- or aluminum-containing antacids. Other cations, including calcium, iron, and zinc, also appear to interfere with ofloxacin absorption. May have additive effect with ANTIDIABETICS.

Pharmacokinetics

Absorption: 90–98% from GI tract. Peak: 1–2 h. Distribution: Distributes to most tissues; 50% crosses into CSF with inflamed meninges; 20–32% protein bound; crosses placenta; distributed into breast milk. Metabolism: Slightly in liver. Elimination: 72–98% in urine within 48 h. Half-Life: 5–7.5 h.

Nursing Implications

Assessment & Drug Effects

  • Lab tests: Do C&S tests prior to initial dose. Treatment may be implemented pending results.
  • Determine history of hypersensitivity reactions to quinolones or other drugs before therapy is started.
  • Withhold ofloxacin and notify physician at first sign of tendon pain, a skin rash, or other allergic reaction.
  • Monitor for seizures, especially in patients with known or suspected CNS disorders. Discontinue ofloxacin and notify physician immediately if seizure occurs.
  • Assess for signs and symptoms of superinfection (see Appendix F).

Patient & Family Education

  • Drink fluids liberally unless contraindicated.
  • Be aware that dizziness or light-headedness may occur; use appropriate caution.
  • Avoid excessive sunlight or artificial ultraviolet light because of the possibility of phototoxicity.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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