Ofloxacin

Oral
Non-gonococcal cervicitis/urethritis due to Chlamydia trachomatis
Adult: 400 mg daily as single or in divided doses. Alternatively, 300 mg 12 hourly. Treatment duration: 7 days.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100 mg 24 hourly or 200 mg 48 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg or half of the usual recommended dose 24 hourly following usual initial dose.
20-50	100-200 mg daily or the usual recommended dose 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.
Incompatibility: IV: Heparin.

Oral
Uncomplicated gonorrhoea
Adult: 400 mg as a single dose.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100-200 mg 24 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg or half of the usual recommended dose 24 hourly following usual initial dose.
20-50	100-200 mg daily or the usual recommended dose 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.

Oral
Acute exacerbations of chronic bronchitis
Adult: 400 mg 12 hourly for 10 days.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100-200 mg 24 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg or half of the usual recommended dose 24 hourly following usual initial dose.
20-50	100-200 mg daily or the usual recommended dose 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.

Oral
Community-acquired pneumonia
Adult: 400 mg 12 hourly for 10 days.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100-200 mg 24 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg or half of the usual recommended dose 24 hourly following usual initial dose.
20-50	100-200 mg daily or the usual recommended dose 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.

Oral
Uncomplicated skin and skin structure infections
Adult: 400 mg 12 hourly for 10 days.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100-200 mg 24 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg or half of the usual recommended dose 24 hourly following usual initial dose.
20-50	100-200 mg daily or the usual recommended dose 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.

Oral
Complicated urinary tract infections
Adult: 200 mg 12 hourly for 10 days. Alternatively, 200 mg bid, may be increased to 400 mg bid according to severity for 7-21 days.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100-200 mg 24 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg or half of the usual recommended dose 24 hourly following usual initial dose.
20-50	100-200 mg daily or the usual recommended dose 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.

Oral
Skin and soft tissue infections
Adult: 400 mg bid.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100-200 mg 24 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg or half of the usual recommended dose 24 hourly following usual initial dose.
20-50	100-200 mg daily or the usual recommended dose 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.

Oral
Uncomplicated urinary tract infections
Adult: 200 mg 12 hourly for 3-7 days.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100-200 mg 24 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg or half of the usual recommended dose 24 hourly following usual initial dose.
20-50	100-200 mg daily or the usual recommended dose 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.

Oral
Uncomplicated cystitis
Adult: 200 mg 12 hourly for 3-7 days.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100-200 mg 24 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg or half of the usual recommended dose 24 hourly following usual initial dose.
20-50	100-200 mg daily or the usual recommended dose 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.

Oral
Acute pelvic inflammatory disease
Adult: 400 mg 12 hourly for 10-14 days.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100-200 mg 24 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg or half of the usual recommended dose 24 hourly following usual initial dose.
20-50	100-200 mg daily or the usual recommended dose 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.

Oral
Prostatitis
Adult: 200 mg bid, may be increased to 400 mg bid according to severity. Treatment duration: 2-4 weeks (acute); 4-8 weeks (chronic). Alternatively, 300 mg 12 hourly for 6 weeks.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100-200 mg 24 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg or half of the usual recommended dose 24 hourly following usual initial dose.
20-50	100-200 mg daily or the usual recommended dose 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.

Oral
Lower respiratory tract infections
Adult: 400 mg daily, increased to 400 mg bid if necessary.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100-200 mg 24 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg or half of the usual recommended dose 24 hourly following usual initial dose.
20-50	100-200 mg daily or the usual recommended dose 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.

Intravenous
Community-acquired pneumonia
Adult: 200 mg bid via slow infusion over at least 30 minutes.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100 mg 24 hourly or 200 mg 48 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg 24 hourly or 200 mg 48 hourly following usual initial dose.
20-50	100-200 mg 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.
Incompatibility: IV: Heparin.

Intravenous
Acute exacerbations of chronic bronchitis
Adult: 200 mg bid via slow infusion over at least 30 minutes.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100 mg 24 hourly or 200 mg 48 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg 24 hourly or 200 mg 48 hourly following usual initial dose.
20-50	100-200 mg 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.
Incompatibility: IV: Heparin.

Intravenous
Complicated skin and soft tissue infections
Adult: 400 mg bid via slow infusion over at least 1 hour.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100 mg 24 hourly or 200 mg 48 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg 24 hourly or 200 mg 48 hourly following usual initial dose.
20-50	100-200 mg 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.
Incompatibility: IV: Heparin.

Intravenous
Complicated urinary tract infections
Adult: 200 mg bid via slow infusion over at least 30 minutes, may be increased according to severity to 400 mg bid infused over at least 1 hour. Treatment duration: 7-21 days.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100 mg 24 hourly or 200 mg 48 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg 24 hourly or 200 mg 48 hourly following usual initial dose.
20-50	100-200 mg 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.
Incompatibility: IV: Heparin.

Intravenous
Lower respiratory tract infections
Adult: 200 mg bid via infusion over at least 30 minutes, may be increased according to severity to 400 mg bid infused over at least 1 hour.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100 mg 24 hourly or 200 mg 48 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg 24 hourly or 200 mg 48 hourly following usual initial dose.
20-50	100-200 mg 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.
Incompatibility: IV: Heparin.

Intravenous
Pyelonephritis
Adult: 200 mg bid via slow infusion over at least 30 minutes, may be increased according to severity to 400 mg bid infused over at least 1 hour. Treatment duration: 7-10 days, up to 14 days as necessary.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100 mg 24 hourly or 200 mg 48 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg 24 hourly or 200 mg 48 hourly following usual initial dose.
20-50	100-200 mg 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.
Incompatibility: IV: Heparin.

Intravenous
Prostatitis
Adult: 200 mg bid via slow infusion over at least 30 minutes, may be increased according to severity to 400 mg bid infused over at least 1 hour. Treatment duration: 2-4 weeks (acute); 4-8 weeks (chronic).
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100 mg 24 hourly or 200 mg 48 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg 24 hourly or 200 mg 48 hourly following usual initial dose.
20-50	100-200 mg 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.
Incompatibility: IV: Heparin.

Intravenous
Epididymo-orchitis
Adult: 200 mg bid via slow infusion over at least 30 minutes, may be increased according to severity to 400 mg bid infused over at least 1 hour. Treatment duration: 14 days.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100 mg 24 hourly or 200 mg 48 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg 24 hourly or 200 mg 48 hourly following usual initial dose.
20-50	100-200 mg 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.
Incompatibility: IV: Heparin.

Intravenous
Pelvic inflammatory disease
Adult: 400 mg bid via slow infusion over at least 1 hour for 14 days.
Renal impairment: Patient on haemodialysis or peritoneal dialysis: 100 mg 24 hourly or 200 mg 48 hourly following usual initial dose.

CrCl (ml/min)	Dosage Recommendation
<20	100 mg 24 hourly or 200 mg 48 hourly following usual initial dose.
20-50	100-200 mg 24 hourly following usual initial dose.

Hepatic impairment: Severe: Reduce dose. Max: 400 mg daily.
Incompatibility: IV: Heparin.

Ophthalmic
Bacterial conjunctivitis
Adult: As 0.3% eye drop solution: Instill 1-2 drops into the affected eye(s) 2-4 hourly for days 1 and 2, then instill 1-2 drops 4 times daily for days 3-7. Max treatment duration: 10 days.
Child: ≥1 year Same as adult dose.

Ophthalmic
Bacterial corneal ulcer
Adult: As 0.3% eye drop solution: Instill 1-2 drops into the affected eye(s) every 30 minutes while awake and 4-6 hourly after retiring for days 1 and 2. Starting on day 3, instill 1-2 drops hourly while awake for 4-6 additional days; thereafter, 1-2 drops 4 times daily until clinical cure is achieved.
Child: ≥1 year Same as adult dose.

Otic/Aural
Otitis externa
Adult: As 0.3% otic solution: Instill 10 drops (1.5 mg) into the canal of the affected ear(s) once daily for 7 days.
Child: 6 months to 13 years Instill 5 drops (0.75 mg) into the canal of the affected ear(s) once daily for 7 days; >13 years Same as adult dose.

Otic/Aural
Otitis media
Adult: Chronic suppurative cases with perforated tympanic membranes: As 0.3% otic solution: Instill 10 drops (1.5 mg) into the canal of the affected ear(s) bid for 14 days.
Child: ≥12 years Same as adult dose.

Otic/Aural
Acute otitis media
Child: With tympanostomy tubes: 1-12 years As 0.3% otic solution: Instill 5 drops (0.75 mg) into the canal of the affected ear(s) bid for 10 days.

May be taken with or without food. Avoid antacids or supplements containing Fe or Zn w/in 2 hr before or after ofloxacin. Ensure adequate hydration.

Hypersensitivity to ofloxacin or to other quinolone antibacterials. History of tendon disorders associated with quinolone use, epilepsy or lowered seizure threshold.

Patient with known/suspected CNS disorders (e.g. epilepsy, severe cerebral arteriosclerosis) or risk factors that may predispose to seizures or lower the seizure threshold; myasthenia gravis, rheumatoid arthritis, latent or diagnosed G6PD deficiency, risk factors for QT interval prolongation (e.g. congenital long QT syndrome, uncorrected hypokalaemia or hypomagnesaemia, heart failure, MI, bradycardia), history of aneurysm disease, pre-existing aortic aneurysm/dissection or its predisposing conditions (e.g. Marfan syndrome, vascular Ehlers-Danlos syndrome, Takayasu/giant cell arteritis, Behcet's disease); psychiatric disease, history of psychotic disorder or risk factor for depression; diabetes. Organ transplant recipients. Not indicated for the treatment of syphilis as it may mask symptoms (oral). Renal and hepatic impairment. Children and elderly. Pregnancy and lactation. Patient Counselling This drug may cause drowsiness, dizziness and visual disturbances; if affected, do not drive or operate machinery. Avoid excessive exposure to sunlight or artificial UV light. Do not wear contact lenses during treatment of ophthalmic infections. Monitoring Parameters Monitor CBC, hepatic and renal function periodically (prolonged therapy). Perform culture and sensitivity tests and consult local recommendations before treatment initiation due to antibiotic resistance risks; test for syphilis at the time of gonorrheal diagnosis and 3 months later. Assess for signs and symptoms of glucose disturbances, CNS effects, and tendon problems. Monitor ofloxacin serum concentration for patient with severe renal impairment and on dialysis (IV).

Significant: Tendon rupture or tendinitis, aortic aneurysm ruptures or dissection, CNS effects (e.g. seizures, tremors, dizziness, lightheadedness, increased intracranial pressure), hyperglycaemia, psychiatric reactions (e.g. hallucinations, toxic psychosis), phototoxicity. Rarely, peripheral neuropathy, QT interval prolongation, torsades de pointes, haemolytic reactions (G6PD deficient patients). Cardiac disorders: Chest pain. Ear and labyrinth disorders: Vertigo. Otic: Earache, application site reactions. Eye disorders: Visual disturbance. Ophthalmic: Blurred vision, ocular burning or discomfort (transient), lacrimation, photophobia, foreign body sensation in eyes, chemical conjunctivitis, keratitis; eye discomfort, dryness, pain, pruritus or redness. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, constipation, dysgeusia, abdominal pain or cramps, flatulence, gastrointestinal distress, dry mouth. General disorders and administration site conditions: Fever, infusion site reaction (IV). Infections and infestations: Pathogen resistance, fungal infection. Metabolism and nutrition disorders: Decreased appetite. Nervous system disorders: Headache, dizziness, drowsiness. Psychiatric disorders: Insomnia, agitation, sleep disorder, nervousness, somnolence. Reproductive system and breast disorders: Vaginitis, genital pruritus. Respiratory, thoracic and mediastinal disorders: Nasopharyngitis, cough. Skin and subcutaneous tissue disorders: Pruritus, rash. Vascular disorders: Phlebitis (IV).
Potentially Fatal: Fungal or bacterial superinfection including C. difficile-associated diarrhoea (CDAD) and pseudomembranous colitis (prolonged use); liver failure, myasthenia gravis exacerbation, severe hypoglycaemia. Rarely, severe bullous skin reactions (e.g. toxic epidermal necrolysis, Stevens-Johnson syndrome), hypersensitivity reactions (e.g. anaphylaxis, anaphylactic shock).

Symptoms: Dizziness, confusion, impaired consciousness, increased QT interval, convulsive seizures, nausea, mucosal erosions. Management: Symptomatic treatment. May employ gastric lavage or administer adsorbents and Na sulfate during the 1st 30 minutes to remove any unabsorbed drug. Antacids may be given for protection of gastric mucosa. Elimination may be increased by forced diuresis. Monitor ECG.

Increased risk of tendon rupture or inflammation with concomitant use of corticosteroids. Increased risk of QT interval prolongation with Class IA and III anti-arrhythmics, TCAs, macrolides, antipsychotics. May increase the risk of bleeding when given with vitamin K antagonists (e.g. warfarin). Reduced absorption with Mg-, Ca- or Al-containing antacids, Zn or Fe preparations, sucralfate and didanosine chewable or buffered tab. Decreased clearance with drugs that affect the renal tubular secretion (e.g. probenecid, furosemide, cimetidine, methotrexate). May slightly increase plasma levels of glibenclamide. Theophylline and NSAIDs may cause pronounced lowering of cerebral seizure threshold.

May enhance CNS effects with alcohol.

May cause false-positive results in the determination of opiates or porphyrin levels in urine.

Ofloxacin is a fluoroquinolone antibacterial which inhibits bacterial topoisomerase IV and DNA gyrase enzymes required for DNA replication, transcription, repair, transposition and recombination.
Absorption: Rapidly and well absorbed from the gastrointestinal tract. Well maintained in the tear-film after ophthalmic instillation. Bioavailability: Approx 98% (oral). Time to peak plasma concentration: 1-2 hours.
Distribution: Widely distributed into body fluids, including CSF; good penetration into tissues. Crosses the placenta and enters breast milk. Volume of distribution: 120 L. Plasma protein binding: Approx 20-32%.
Metabolism: Limited metabolism to desmethyl and N-oxide metabolites.
Excretion: Via urine (65-80% as unchanged drug; <5% as metabolites); faeces (4-8%). Elimination half-life: Approx 9 hours; Biphasic: Approx 4-5 hours and 20-25 hours.

Intravenous: IV solution: Store between 20-25°C. Protect from light. Ophthalmic: Ophthalmic solution: Store between 15-25°C. Protect from light and excessive heat. Oral: IV solution: Store between 20-25°C. Protect from light. Otic/Aural: Otic solution: Store between 20-25°C. Protect from light.

Ear Anti-Infectives & Antiseptics / Eye Anti-Infectives & Antiseptics / Quinolones

J01MA01 - ofloxacin ; Belongs to the class of fluoroquinolones. Used in the systemic treatment of infections.
S01AE01 - ofloxacin ; Belongs to the class of quinolone antiinfectives. Used in the treatment of eye infections.
S02AA16 - ofloxacin ; Belongs to the class of antiinfectives used in the treatment of ear infections.