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Paul A. Pham Pharm.D. and John G. Bartlett M.D.
09-24-2009
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Available formulation in Zambia: Tablet: 200 mg; 400 mg.
- MDRTB standardized regimen: ofloxacin 600 mg/d (<65 kg); 800 mg/d (>65 kg) plus ethionamide, kanamycin, pyrazinamide, and ethambutol x 4 month, then based on culture conversion and sensitivity, continue with ethionamide, ofloxacin, and ethambutol for 12-18 months.
- Compared to ciprofloxacin, more active against Chlamydia trachomatis
Zambia Information Author: Paul A. Pham Pharm.D.
- Acute exacerbation of chronic bronchitis (AECB) and community-acquired pneumonia (CAP)
- Pelvic Inflammatory Disease (PID). Endocervical and urethral gonorrhea (note: high resistance rates in U.S. and world-wide, no longer recommended) and chlamydia infections. Nongonococcal urethritis and cervicitis due to C. trachomatis.
- Uncomplicated and complicated UTI
- Prostatitis due to E. coli
- Skin and soft tissue infections
- Otitis externa, chronic suppurative otitis media, otitis media (otic solution)
- Conjunctivitis, keratitis and corneal ulcers (ophthalmic solution)
- Peritonitis, spontaneous bacterial & secondary
- Proctitis [sexually transmitted]
- Sexually-associated reactive arthritis (SARA)
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
| Floxin | Ofloxacin | Ortho-McNeil and generic manufacturer | PO
tab
200mg | $4.79 |
|
|
|
| PO
tab
300mg | $5.70 |
|
|
|
| PO
tab
400mg | $6.01 |
| Ocuflox | Ofloxacin | Allergan; Bausch & Lomb | ophthalmic
gtt
0.3% (5ml) | $54.65 |
|
|
|
| ophthalmic
gtt
0.3% (10mL) | $83.30 |
| Floxin | Ofloxacin | Falcon | otic
gtt
0.3%(10mL) | $127.00 |
|
|
|
| otic
gtt
0.3% (5mL) | $82.50 |
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
- CAP, soft tissue infection and AECB : 400mg PO twice daily.
- Uncomplicated UTI : 200 mg PO twice daily x 3-7d.
- NonGC cervicitis/urethritis: 300mg twice daily x 7d.
- Conjunctivitis, keratitis: 1-2 ophthalmic drops q 2-4 hrs x 2 d then q6h for a total of 7-10 d.
- Corneal ulcer: 1-2 ophthalmic drops every 30 minutes while awake x 2d, then hourly while awake during days 3-9, then four times daily (consult ophthalmology).
- Otitis externa : 10 drops (otic solution) into affected ear(s) once daily x 7d.
Usual dose.
200-400 mg q24h.
100-200 mg q24h.
200 mg, then 100mg q24h.
100-200mg q24h.
No data. Consider 400 mg q24h.
- GI: diarrhea
- CNS: headache, malaise, insomnia, restlessness, dizziness
- Allergic reactions: rash, hives
-
C. difficilecolitis
- Photosensitivity/phototoxicity (can be severe)
- Tendon rupture (increased incidence seen in older pts with concurrent use of corticosteroids)
- Increased LFTs
- Peripheral neuropathy
- QTc prolongation
- Seizure
- Severe allergic reactions (TEN, Stevens-Johnsons syndrome, allergic pneumonitis, hepatitis, and bone marrow suppression)
- Interstitial nephritis
- Antiarrhythmic agents (prolong the QT interval including class Ia or class III): avoid especially in pts with hypokalemia, significant bradycardia, or cardiomyopathy.
- Divalent or trivalent cations (e.g., antacids, sucralfate, buffered ddI, vitamins, and minerals): interferes with ofloxacin absorption. Do not co-administer or give ofloxacin 2 hrs before cations.
- NSAIDS: may increase risk of CNS side effects (clinical significance unknown). Monitor closely.
- Procainamide: procainamide levels may be increased. Monitor closely with co-administration.
- Warfarin: may increase INR with co-administration. Monitor closely.
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Staphylococcus spp. breakpoints: < 1 mcg/mL (sensitive); 2 mcg/mL (intermediate); > 4 mcg/mL (resistant).
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S. pneumoniaebreakpoints: < 2 mcg/mL (sensitive); 4 mcg/mL (intermediate); > 8 mcg/mL (resistant).
Oral FQ that has been largely supplanted by levofloxacin,its more active L-isomer. IV formulation is no longer available. Ofloxacin ophthalmic drops is equivalent to ciprofloxacin ophthalmic drops in the treatment of corneal ulcer. Ofloxacin is preferred over cipro due to a 20% incidence crystalline precipitate in the epithelial defect seen with ciprofloxacin drops.
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