• PO: Treatment of the following infections:
  • Acute bacterial exacerbations of chronic bronchitis (should be used only when there are no other alternative treatment options),
  • Community-acquired pneumonia (CAP),
  • Acute uncomplicated cervical and urethral gonorrhea,
  • Nongonococcal urethritis and cervicitis,
  • Mixed infections of the urethra and cervix,
  • Acute pelvic inflammatory disease,
  • Urinary tract infections (should be used for acute uncomplicated cystitis only when there are no other alternative treatment options),
  • Prostatitis,
  • Uncomplicated skin and skin structure infections.
• Otic: Otitis externa or otitis media.

Contraindicated in:

• Hypersensitivity (cross-sensitivity within class may exist)
• QTc interval prolongation
• Uncorrected hypokalemia or hypomagnesemia
• Concurrent use of Class IA antiarrhythmics (disopyramide, quinidine, procainamide) or Class III antiarrhythmics (amiodarone, sotalol) (↑risk of QTc interval prolongation and torsade de pointes)
• History of myasthenia gravis (may worsen symptoms including muscle weakness and breathing problems)
• Lactation: Lactation.

Use Cautiously in:

• Known or suspected CNS disorder
• Renal impairment (dose reduction recommended if CCr 50 mL/min)
• Cirrhosis
• Concurrent use of corticosteroids (↑ risk of tendinitis/tendon rupture)
• Kidney, heart, or lung transplant patients (↑ risk of tendinitis/tendon rupture)
• Patients with or at risk for aortic aneurysms
• OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;.
• Pedi: Safety and effectiveness not established in children
• Geri: ↑risk for tendon disorders/rupture, hepatotoxicity, aortic aneurysm/dissection (within 2 mo following discontinuation), and QT interval prolongation.

CV: QT interval prolongation, AORTIC ANEURYSM/DISSECTION, TORSADE DE POINTES.

Derm: photosensitivity, rash, STEVENS-JOHNSON SYNDROME.

Endo: hyperglycemia, hypoglycemia.

GI: diarrhea, nausea, CLOSTRIDIOIDES DIFFICILE-ASSOCIATED DIARRHEA (CDAD), abdominal pain, vomiting.

GU: vaginitis.

MS: arthralgia, myalgia, tendinitis, tendon rupture.

Neuro: agitation, anxiety, confusion, depression, dizziness , ELEVATED INTRACRANIAL PRESSURE (INCLUDING PSEUDOTUMOR CEREBRI), hallucinations, headache, insomnia, nightmares, paranoia, peripheral neuropathy, SEIZURES, SUICIDAL THOUGHTS, toxic psychosis, tremor.
Misc: (INCLUDING ANAPHYLAXIS)HYPERSENSITIVITY REACTIONS .

Drug-Drug:

• Concurrent use ofamiodarone, disopyramide, procainamide, dofetilide, quinidine, or sotalol↑ risk of potentially dangerous arrhythmias in susceptible individuals (avoid concurrent use).
• May ↑ theophylline levels and the risk of toxicity.
• Administration with antacids, iron salts, bismuth subsalicylate,sucralfate, and zinc salts↓ absorption.
• May ↑ the effects of warfarin.
• Levels and effectiveness may be ↓ by antineoplastic agents.
• Cimetidine may interfere with elimination.
• Probenecid↓ renal elimination.
• May ↑ risk of nephrotoxicity from cyclosporine.
• Concurrent corticosteroid therapy may ↑ risk of tendon rupture.
• May ↑ risk of hypoglycemia when used with antidiabetic agents.

Drug-Food:

• Absorption is impaired by concurrent enteral feeding (because of metal cations).
• Absorption of ofloxacin is ↓ by foods and/or dairy products.

(Generic available)

• Tablets: 200 mg; 300 mg; 400 mg;
• Otic solution: 0.3%;

Acute Bacterial Exacerbations of Chronic Bronchitis

• PO (Adults): 400 mg every 12 hr for 10 days.

Community-Acquired Pneumonia

• PO (Adults): 400 mg every 12 hr for 10 days.

Uncomplicated Skin/Skin Structure Infections

• PO (Adults): 400 mg every 12 hr for 10 days.

Uncomplicated Urethral and Cervical Gonorrhea

• PO (Adults): 400 mg single dose.

Nongonococcal Urethritis/Cervicitis

• PO (Adults): 300 mg every 12 hr for 7 days.

Mixed Infection of the Urethra and Cervix

• PO (Adults): 300 mg every 12 hr for 7 days.

Acute Pelvic Inflammatory Disease

• PO (Adults): 400 mg every 12 hr for 10–14 days.

Urinary Tract Infections

• PO (Adults): Uncomplicated cystitis due to E. coli or Klebsiella pneumoniae: 200 mg every 12 hr for 3 days; Uncomplicated cystitis due to Citrobacter diversus, Enterobacter aerogenes, Proteus mirabilis, or Pseudomonas aeruginosa: 200 mg every 12 hr for 7 days; Complicated urinary tract infection: 200 mg every 12 hr for 10 days.

Prostatitis

• PO (Adults): 300 mg every 12 hr for 6 wk.

Floxin, Floxin Otic

• Inhibits bacterial DNA synthesis by inhibiting DNA gyrase enzyme.

• Death of susceptible bacteria.

Spectrum:

• Active against gram-positive pathogens including:
  • Staphylococcus aureus,
  • Staphylococcus epidermidis,
  • Streptococcus pyogenes,
  • Streptococcus pneumoniae.
• Gram-negative spectrum notable for activity against:
  • Escherichia coli,
  • Klebsiella pneumoniae,
  • Enterobacter aerogenes,
  • Proteus mirabilis,
  • Haemophilus influenzaeNeisseria gonorrhoeae,
  • Moraxella catarrhalis.
• Additional spectrum includes:
  • Chlamydophylia pneumoniae,
  • Legionella pneumoniae,
  • Mycoplasma pneumoniae.

Therapeutic Classification: anti-infectives

Pharmacologic Classification: Fluoroquinolones

Absorption: Well absorbed (98%) following oral administration.

Distribution: Widely distributed. High tissue and urinary levels are achieved. Appears to cross the placenta; enters breast milk.

Metabolism/Excretion: 70–80% excreted unchanged by the kidneys.

Half-life: 5–7 hr.

(blood levels)

• Instruct patient to take medication as directed at evenly spaced times and to finish drug completely, even if feeling better. Take missed doses as soon as possible, unless almost time for next dose. Do not double doses. Advise patient that sharing of this medication may be dangerous.
• Advise patients to notify health care professional immediately if they are taking theophylline.
• Encourage patient to maintain a fluid intake of at least 1500–2000 mL/day to prevent crystalluria.
• Advise patient that antacids or medications containing calcium, magnesium, aluminum, iron, or zinc will decrease absorption and should not be taken within 4 hr before and 2 hr after taking this medication.
• May cause dizziness and drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
• Advise patient to notify health care professional of any personal or family history of QTc prolongation or proarrhythmic conditions such as recent hypokalemia, significant bradycardia, or recent myocardial ischemia or if fainting spells or palpitations occur. Patients with this history should not receive ofloxacin.
• Caution patient to use sunscreen and protective clothing to prevent phototoxicity reactions during and for 5 days after therapy. Notify health care professional if a sunburn-like reaction or skin eruption occurs.
• Advise patient that frequent mouth rinses, good oral hygiene, and sugarless gum or candy may minimize dry mouth.
• Instruct patients being treated for gonorrhea that partners also must be treated.
• Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools).
• Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
• Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
• Instruct patient to notify health care professional immediately if rash, jaundice, signs of hypersensitivity, or tendon (shoulder, hand, Achilles, and other) pain, swelling, or inflammation occur. If tendon symptoms occur, avoid exercise and use of the affected area. Increased risk in >65 yrs old, kidney, heart and lung transplant recipients, and patients taking corticosteroids concurrently. Therapy should be discontinued.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
• Otic: Instruct parent in correct administration technique.

oh-FLOX-a-sin