Ofloxacin

From WikEM
Jump to: navigation, search

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[1]

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

References

  1. Sanford Guide to Antimicrobial Therapy 2014