Ofloxacin

General

• Type: Fluroquinolones
• Dosage Forms: 200,300,400
• Common Trade Names: Floxin

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

Pediatric Dosing

PID

• >12yrs: 400mg PO BID x 14d

Typhoid fever

• 20mg/kg BID x 10d, max 400mg/dose

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
• seizures
• phototoxicity
• superinfection
• increased ICP
• toxic psychosis
• vasculitis
• serum sickness
• hypersensitivity pneumonitis
• QT prolongation
• torsades de pointes
• peripheral neuropathy
• hepatotoxicity
• nephrotoxicity
• crystalluria
• myelosuppression
• blood dyscrasias
• tendon rupture
• myasthenia exacerbation

Common

• nausea/vomiting
• diarrhea
• abnormal ECG
• headache
• dyspepsia
• dizziness
• vaginitis
• insomnia
• photosensitivity
• pruritus
• anxiety
• agitation
• tendinitis
• elevated LFTs

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

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

• Antibiotics (Main)

References

Authors

Ross Donaldson, Ann Huang, Claire, Daniel Ostermayer, Neil Young