Ofloxacin: Difference between revisions
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==General== | ==General== | ||
*Type: [[Fluroquinolones]] | *Type: [[Fluroquinolones]] | ||
*Dosage Forms: 200,300,400 | *Dosage Forms: 200,300,400, topical/otic | ||
*Common Trade Names: Floxin | *Common Trade Names: Floxin, Floxin Otic | ||
==Adult Dosing== | ==Adult Dosing== | ||
=== | ===Infections, bacterial=== | ||
*200-400mg PO q12h | *200-400mg PO q12h | ||
=== | ===Infections, [[chlamydial]]=== | ||
*300mg PO q12h x 7d | *300mg PO q12h x 7d | ||
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===[[Typhoid fever]]=== | ===[[Typhoid fever]]=== | ||
*400mg PO q12h x 7-14d | *400mg PO q12h x 7-14d | ||
===[[Otitis Externa]]=== | |||
*5 drops in affected ear BID x 7 days<ref name="CPGENT2014">Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161 DOI: 10.1177/0194599813517659 [http://www.aepap.org/sites/default/files/otitis_externa_guia2014-rosenfeld-161-8_0.pdf PDF]</ref> | |||
**Safe with perforations | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
===[[PID]]=== | |||
*>12yrs: 400mg PO BID x 14d | |||
===[[Typhoid fever]]=== | |||
*20mg/kg BID x 10d, max 400mg/dose | |||
* | ===[[Otitis Externa]]=== | ||
* | *6mo-13 yo: 5 drops in affected ear BQD x 7 days | ||
*>13 yo: 5 drops in affected ear BID x 7 days<ref name="CPGENT2014">Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161 DOI: 10.1177/0194599813517659 [http://www.aepap.org/sites/default/files/otitis_externa_guia2014-rosenfeld-161-8_0.pdf PDF]</ref> | |||
==Special Populations== | ==Special Populations== | ||
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*myasthenia gravis | *myasthenia gravis | ||
*prolonged QT | *prolonged QT | ||
* | *history of torsades de pointes | ||
*caution if ventricular arrhythmias, bradycardia, recent MI | *caution if ventricular arrhythmias, bradycardia, recent MI | ||
*caution if CHF, | *caution if CHF, patient > 60 | ||
*caution if | *caution if history of renal, heart, lung transplant | ||
*caution in seizure disorder | *caution in seizure disorder | ||
*caution in DM | *caution in DM | ||
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==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
* | *[[Anaphylaxis]] | ||
* | *[[Seizure]] | ||
* | *Phototoxicity | ||
* | *Superinfection | ||
* | *Increased ICP | ||
* | *Toxic psychosis | ||
* | *[[Vasculitis]] | ||
* | *Serum sickness | ||
* | *Hypersensitivity pneumonitis | ||
*QT prolongation | *[[QT prolongation]] | ||
* | *[[Torsades de pointes]] | ||
* | *Peripheral [[neuropathy]] | ||
* | *Hepatotoxicity | ||
* | *Nephrotoxicity | ||
* | *Crystalluria | ||
* | *Myelosuppression | ||
* | *Blood dyscrasias | ||
*tendon rupture | *Tendonitis or tendon rupture (black box warning) - increased risk in age >60, immunosuppressed, corticosteroid use | ||
* | *Myasthenia exacerbation | ||
*Severe Hypoglycemia <ref>FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions. US Food and Drug Administration. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm612995.htm. Updated July 10, 2018. Accessed Oct 22, 2018.</ref> | |||
*mental health effects | |||
===Common=== | ===Common=== | ||
* | *[[Nausea]]/[[vomiting]] | ||
* | *[[Diarrhea]] | ||
* | *Abnormal ECG | ||
* | *[[Headache]] | ||
* | *[[Dyspepsia]] | ||
* | *[[Dizziness]] | ||
* | *[[Vaginitis]] | ||
* | *Insomnia | ||
* | *Photosensitivity | ||
* | *[[Pruritus]] | ||
* | *Anxiety | ||
* | *Agitation | ||
* | *Tendinitis | ||
* | *Elevated LFTs | ||
==Pharmacology== | ==Pharmacology== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Pharmacology]] | ||
[[Category:ID]] |
Latest revision as of 19:56, 22 September 2019
General
- Type: Fluroquinolones
- Dosage Forms: 200,300,400, topical/otic
- Common Trade Names: Floxin, Floxin Otic
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
Otitis Externa
- 5 drops in affected ear BID x 7 days[1]
- Safe with perforations
Pediatric Dosing
PID
- >12yrs: 400mg PO BID x 14d
Typhoid fever
- 20mg/kg BID x 10d, max 400mg/dose
Otitis Externa
- 6mo-13 yo: 5 drops in affected ear BQD x 7 days
- >13 yo: 5 drops in affected ear BID x 7 days[1]
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
- Adult
- Hepatic Dosing
- Adult
- cirrhosis: max 400mg/24h
- Pediatric
- specific adjustment not defined though adjustment may be required
- Adult
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
- Seizure
- Phototoxicity
- Superinfection
- Increased ICP
- Toxic psychosis
- Vasculitis
- Serum sickness
- Hypersensitivity pneumonitis
- QT prolongation
- Torsades de pointes
- Peripheral neuropathy
- Hepatotoxicity
- Nephrotoxicity
- Crystalluria
- Myelosuppression
- Blood dyscrasias
- Tendonitis or tendon rupture (black box warning) - increased risk in age >60, immunosuppressed, corticosteroid use
- Myasthenia exacerbation
- Severe Hypoglycemia [2]
- mental health effects
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[3]
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
- ↑ 1.0 1.1 Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161 DOI: 10.1177/0194599813517659 PDF
- ↑ FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions. US Food and Drug Administration. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm612995.htm. Updated July 10, 2018. Accessed Oct 22, 2018.
- ↑ Sanford Guide to Antimicrobial Therapy 2014