about Ofloxacin class, uses, side effects contraindications
Ofloxacin
Short Description
Ofloxacin is a quinolone antibiotic that is used to treat various infections caused by bacteria sensitive to this antibiotic, and is specifically used to treat infections in the urinary tract, respiratory tract and some infections in the intestine.
Ofloxacin is distinguished from other quinolones by its high bioavailability when taken orally, and its bioavailability means that a high percentage of the drug reaches the blood plasma.
The main side effects of ofloxacin are: nausea, headache, and rarely hallucinations. When ofloxacin is prescribed to patients with impaired renal function, the dose should be reduced in accordance with the level of renal performance.
Levofloxacin is a fluoroquinolones antibiotic used to treat various types of infections caused by sensitive microorganisms.
It is used to treat the following bacterial infections:
bronchitis.
Sinus infections.
Urinary tract infections.
Pneumonia.
Prostatitis.
skin infections;
Bacterial conjunctivitis.
It may also be used to treat people exposed to anthrax germs or treat and prevent plague, and should only be used for infections that cannot be treated with a safer antibiotic.
The main side effects of this drug are nausea,?abdominal pain?, diarrhea or constipation, and headache.
Category
Chemical class: Selective beta2-adrenergic agonist, sympathomimetic
Therapeutic class: Bronchodilator
Pregnancy category: C
Indications
To prevent exercise-induced asthma INHALATION AEROSOL Adults and children over age 4. 2 inhalations 15 to 30 min before exercise. To treat bronchospasm in patients with reversible obstructive airway disease or acute bronchospastic attack Adults and children over age 12. Initial: 4 or 8 mg every 12 hr. Maximum: 32 mg daily in divided doses every 12 hr. Children ages 6 to 12. Initial: 4 mg every 12 hr. Maximum: 24 mg daily in divided doses every 12 hr. REPETABS Adults and children over age 12. Initial: 4 to 8 mg every 12 hr. Maximum: 32 mg daily in divided doses every 12 hr. Children ages 6 to 11. Initial: 4 mg every 12 hr. Maximum: 24 mg daily in divided doses every 12 hr. SYRUP Adults and children over age 14. Initial: 2 to 4 mg (1 to 2 tsp) t.i.d. or q.i.d. Maximum: 32 mg daily in divided doses. Children ages 6 to 14. Initial: 2 mg (1 tsp) t.i.d. or q.i.d. Maximum: 24 mg daily in divided doses. Children ages 2 to 6. Initial: 0.1 mg/kg t.i.d. (not to exceed 2 mg t.i.d.), increased to 0.2 mg/kg t.i.d. (not to exceed 4 mg t.i.d.). Adults and children over age 12. Initial: 2 or 4 mg t.i.d. or q.i.d. Maximum: 32 mg daily in divided doses. Children ages 6 to 12. Initial: 2 mg t.i.d. or q.i.d. Maximum: 24 mg daily in divided doses.
DOSAGE ADJUSTMENT For elderly patients, initial dosage reduced to 2 mg (1 tsp) of syrup t.i.d. or q.i.d. or 2 mg of tablets t.i.d. or q.i.d. (up to 32 mg daily). INHALATION AEROSOL Adults and children age 4 and over. 1 inhalation every 4 hr to 2 inhalations every 4 to 6 hr. INHALATION (ROTOCAPS) Adults and children age 4 and over. 200 mcg inhaled every 4 to 6 hr using inhalation device. Maximum: 400 mcg every 4 to 6 hr. INHALATION SOLUTION Adults and children age 12 and over. 2.5 mg t.i.d. or q.i.d. by nebulization over 5 to 15 min. Children ages 2 to 12. Initial: 0.1 to 0.15 mg/kg t.i.d. or q.i.d. Maximum: 2.5 mg t.i.d. or q.i.d. Route Onset Peak Duration P.O. ( tab) 30 min 2–3 hr 12 hr P.O. (syrup) Rapid 2 hr Unknown P.O. (tab) 30 min 2–3 hr 4–8 hr Inhalation 5–15 50–55 3–6 hr (aerosol) min min Inhalation 5–15 0.5–3 2–6 hr (rotocap) min hr Inhalation 5–15 1–2 hr 3–6 hr (solution) min
Contraindications
Hypersensitivity to albuterol or its components
Interactions
beta blockers: Inhibited effects of albuterol bronchodilators (sympathomimetics), such as
theophylline: Possibly adverse CV effects digoxin: Decreased serum digoxin level MAO inhibitors, tricyclic antidepressants: Increased vascular effects of albuterol methyldopa: Increased vasopressor effect of methyldopa potassium-lowering : Possibly hypokalemia potassium-wasting diuretics: Possibly increased hypokalemia
Side Efect
CNS: Anxiety, dizziness, drowsiness, headache, hyperkinesia, insomnia, irritability, nervousness, tremor, vertigo, weakness
CV: Angina; arrhythmias, including atrial fibrillation, extrasystoles, supraventricular tachycardia, and tachycardia; chest pain; hypertension; hypotension; palpitations
EENT: Altered taste, dry mouth and throat, ear pain, glossitis, hoarseness, oropharyngeal edema, pharyngitis, rhinitis, taste perversion
ENDO: Hyperglycemia
GI: Anorexia, diarrhea, dysphagia, heartburn, nausea, vomiting
GU: UTI
MS: Muscle cramps
RESP: Bronchospasm, cough, dyspnea, paradoxical bronchospasm, pulmonary edema
SKIN: Diaphoresis, flushing, pallor, pruritus, rash, urticaria
Other: Angioedema, hypokalemia, infection, metabolic acidosis
Cautions
Administer pressurized inhalations of albuterol during second half of inspiration, when airways are open wider and aerosol distribution is more effective.
WARNING Use cautiously in patients with cardiac disorders, diabetes mellitus, digitalis intoxication, hypertension, hyperthyroidism, or history of seizures. Albuterol can worsen these conditions. Monitor serum potassium level because albuterol may cause transient hypokalemia. Be aware that drug tolerance can develop with prolonged use. PATIENT SAFTY
Teach patient to use inhaler. Tell him to shake canister before use and to check that a new canister is working by spraying it the appropriate number of times (once to four times based on manufacturer instructions) into the air while looking for a fine mist. Instruct patient to wash mouthpiece with water once a week and let it air-dry. Advise patient to wait at least 1 minute between inhalations. Tell patient to check with his prescriber before using other inhaled . Warn patient not to exceed prescribed dose or frequency. If doses become less effective, tell patient to contact his prescriber. Tell patient to immediately report signs and symptoms of allergic reaction, such as difficulty swallowing, itching, and rash.
Category
Chemical class: Fluoroquinolone derivative
Therapeutic class: Antibiotic Pregnancy category: C
Indications
To prevent inhalation anthrax after exposure or to treat inhalation anthrax ORAL SUSPENSION, Adults and adolescents.500 mg every 12 hr for 60 days. Children.15 mg/kg every 12 hr for 60 days. Maximum: 500 mg/dose. ciprofloxacin 242
IV: Adults and adolescents.400 mg every 12 hr for 60 days. Children.10 mg/kg every 12 hr for 60 days. Maximum: 400 mg/dose or 800 mg daily. To treat acute sinusitis caused by gramnegative organisms (including Campylobacter jejuni, Citrobacter diversus, Citrobacter freundii, Enterobacter cloacae, Escherichia coli, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Morganella morganii, Neisseria gonorrhoeae, Proteus mirabilis, Proteus vulgaris, Providencia rettgeri, Providencia stuartii, Pseudomonas aeruginosa, Serratia marcescens, Shigella flexneri, and Shigella sonnei) and gram-positive organisms (including Enterococcus faecalis, Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pneumoniae) ORAL SUSPENSION,
Adults.500 mg every 12 hr for 10 days.
IV:
Adults. For mild to moderate infections, 400 mg every 12 hr. To treat bone and joint infections caused by susceptible organisms listed above ORAL SUSPENSION,
Adults.For mild to moderate infections, 500 mg every 12 hr for 4 to 6 wk. For severe or complicated infections, 750 mg every 12 hr for 4 to 6 wk.
IV:
Adults. For mild to moderate infections, 400 mg every 12 hr for 4 to 6 wk. For severe or complicated infections, 400 mg every 8 hr. To treat skin and soft-tissue infections caused by susceptible organisms listed above ORAL SUSPENSION,
Adults.For mild to moderate infections, 500 mg every 12 hr for 7 to 14 days. For severe or complicated infections, 750 mg every 12 hr for 7 to 14 days.
IV:
Adults. For mild to moderate infections, 400 mg every 12 hr. For severe or complicated infections, 400 mg every 8 hr. To treat chronic bacterial prostatitis caused by susceptible organisms listed above ORAL SUSPENSION,
Adults.500 mg every 12 hr for 28 days.
IV:
Adults.400 mg every 12 hr. To treat infectious diarrhea caused by susceptible organisms listed above ORAL SUSPENSION,
Adults.500 mg every 12 hr for 5 to 7 days. To treat UTI caused by susceptible organisms listed above ORAL SUSPENSION,
Adults. For acute uncomplicated infections, 100 mg every 12 hr for 3 days. For mild to moderate infections, 250 mg every 12 hr for 7 to 14 days. For severe or complicated infections, 500 mg every 12 hr for 7 to 14 days.
IV:
Adults.For mild to moderate infections, 200 mg every 12 hr. For severe or complicated infections, 400 mg every 12 hr. To treat complicated UTI caused by E. coli, K. pneumoniae, Enterococcus faecalis, P. mirabilis, or P. aeruginosa or acute uncomplicated pyelonephritis caused by E. coli
Adults. 1,000 mg daily for 7 to 14 days. To treat acute cystitis caused by E. coli, P. mirabilis, E. faecalis, or Staphylococcus saprophyticus
Adults.500 mg daily for 3 days. To treat lower respiratory tract infections caused by susceptible organisms listed above ORAL SUSPENSION,
Adults.For mild to moderate infections, 500 mg every 12 hr for 7 to 14 days. For severe or complicated infections, 750 mg every 12 hr for 7 to 14 days.
IV:
Adults.For mild to moderate infections, 400 mg every 12 hr. For severe or complicated infections, 400 mg every 8 hr. To treat intra-abdominal infections caused by susceptible organisms listed above
IV:
Adults.400 mg every 8 hr along with parenteral metronidazole. To treat mild to severe nosocomial pneumonia caused by susceptible organisms listed above ciprofloxacin 243 C
IV:
Adults.400 mg every 8 hr. To treat typhoid fever caused by Salmonella typhi or infectious diarrhea caused by C. jejuni, E. coli, S. flexneri, or S. sonnei ORAL SUSPENSION,
Adults.500 mg every 12 hr for 10 days. To treat uncomplicated urethral or cervical gonococcal infections caused by N. gonorrhoeae ORAL SUSPENSION,
Adults. 250 mg as a single dose.
DOSAGE ADJUSTMENT Dosage reduced to 250 to 500 mg every 12 hr if creatinine clearance is 30 to 50 ml/min/1.73 m2; and to 250 to 500 mg P.O. or 200 to 400 mg I.V. every 18 hr if creatinine clearance is 5 to 29 ml/min/1.73 m2. To treat acute cystitis caused by E. coli or K. pneumoniae (PROQUIN XR)
Adults. 500 mg daily for 3 days with evening meal. Mechanism of Action
Inhibits the enzyme DNA gyrase, which is responsible for the unwinding and supercoiling of bacterial DNA before it replicates. By inhibiting this enzyme, ciprofloxacin causes bacterial cells to die. Incompatibilities
Don’t administer parenteral ciprofloxacin with aminophylline, amoxicillin, cefepime, clindamycin, dexamethasone, floxacillin, furosemide, heparin, or phenytoin. Contraindications
Hypersensitivity to ciprofloxacin, quinolones, or their components Interactions
antacids, didanosine, iron supplements, sucralfate, multivitamins that contain iron or zinc: Decreased ciprofloxacin absorption cyclosporine: Elevated serum creatinine and blood cyclosporine levels glyburide: Severe hypoglycemia methotrexate: Increased blood methotrexate level and increased risk of toxicity NSAIDs (except acetylsalicylic acid): Increased risk of seizures with high doses of ciprofloxacin oral anticoagulants: Enhanced anticoagulant effects
phenytoin: Increased or decreased blood phenytoin level probenecid: Increased blood ciprofloxacin level and, possibly, toxicity
theophylline: Increased blood level, half-life, and risk of adverse effects of theophylline tizanidine: Increased tizanidine effects caffeine: Increased caffeine effects dairy products: Delayed drug absorption Side Efect
CNS: Agitation, anxiety, cerebral thrombosis, confusion, dizziness, headache, insomnia, light-headedness, migraine, nightmares, paranoia, peripheral neuropathy, restlessness, seizures, syncope, toxic psychosis
CV: Angina, atrial flutter, cardiopulmonary arrest, cardiovascular collapse, hypertension, MI, orthostatic hypotension, palpitations, phlebitis, tachycardia, torsades de pointes, vasculitis, ventricular ectopy
EENT: Oral candidiasis
GI: Abdominal pain, constipation, diarrhea, elevated liver function test results, flatulence, GI bleeding, hepatic failure or necrosis, hepatitis, indigestion, intestinal perforation, jaundice, nausea, pancreatitis, pseudomembranous colitis, vomiting
GU: Crystalluria, hematuria, increased serum creatinine level, interstitial nephritis, nephrotoxicity, renal calculi, renal failure, urine retention, vaginal candidiasis
HEME: Agranulocytosis, bone marrow depression, hemolytic anemia, lymphadenopathy, pancytopenia
MS: Tendinitis, tendon rupture
SKIN: Erythema multiforme, exfoliative dermatitis, photosensitivity, rash, StevensJohnson syndrome, toxic epidermal necrolysis, urticaria
RESP: Bronchospasm, pulmonary embolism, respiratory arrest
Other: Acidosis, anaphylaxis, angioedema, serum sicknesslike reaction Cautions
Obtain culture and sensitivity test results, as ordered, before giving ciprofloxacin. Use drug cautiously in patients with CNS disorders and patients who may be more susceptible to drug’s effect on QT interval, such as those taking Class IA or III antiarciprofloxacin 244 rhythmics or those with uncorrected hypokalemia or a history of QT-interval prolongation. Dilute I.V. ciprofloxacin concentrate to 1 to 2 mg/ml using D5W or sodium chloride for injection. Don’t dilute solutions that come from manufacturer in D5W before I.V. infusion. Infuse slowly over 1 hour. Store reconstituted solution up to 14 days at room temperature or refrigerated. Don’t give oral suspension by feeding tube. Be aware that and immediate-release tablets aren’t interchangeable and that Proquin XR and Cipro XR aren’t interchangeable. Patient should be well hydrated during therapy to help prevent alkaline urine, which may lead to crystalluria and nephrotoxicity. Assess patient’s hepatic, renal, and hematologic functions periodically, as ordered, if he’s receiving prolonged therapy. Monitor patient closely for diarrhea, which may reflect pseudomembranous colitis. If it occurs, notify prescriber and expect to withhold drug and treat diarrhea. Assess patient for evidence of peripheral neuropathy. Notify prescriber and expect to stop drug if patient complains of burning, numbness, pain, tingling, or weakness in extremities or if physical examination reveals deficits in light touch, pain, temperature, position sense, vibratory sensation, or motor strength. Monitor patients (especially children, elderly patients, patients receiving corticosteroids, and patients who have renal failure or who have had a kidney, heart, or lung transplant) for evidence of tendon rupture, such as inflammation, pain, and swelling at the site. Be aware that tendon rupture may occur during or after ciprofloxacin therapy. Notify prescriber about suspected tendon rupture, and have patient rest and refrain from exercise until tendon rupture has been ruled out. If present, expect to provide supportive care as ordered. Assess patient routinely for signs of rash or other hypersensitivity reactions, even after patient has received multiple doses. Stop drug at first sign of rash, jaundice, or other sign of hypersensivitity, and notify prescriber immediately. Be prepared to provide supportive emergency care. PATIENT SAFTY
Urge patient to complete the prescribed course of therapy, even if he feels better before it’s finished. Tell patient not to take drug with dairy products or calcium-fortified juices alone. Advise patient to take ciprofloxacin 2 hours before or 6 hours after antacids, iron supplements, or multivitamins that contain iron or zinc. Tell him to shake oral suspension for 15 seconds, not to chew microcapsules, and not to split, crush, or chew tablets. Encourage patient to drink plenty of fluids during therapy to help prevent crystalluria. Urge patient to avoid caffeinated products because caffeine may accumulate in the body during ciprofloxacin therapy and cause excessive stimulation. Caution patient to avoid excessive exposure to sunlight or artificial ultraviolet light because severe sunburn may result. Tell patient to notify prescriber if sunburn develops; drug will need to be stopped. Urge patient to avoid hazardous activities until CNS effects of drug are known. Advise patient to notify prescriber about changes in limb sensation or movement and about inflammation, pain, or swelling over a joint. Urge patient to rest the affected limb at the first sign of discomfort. Tell patient to stop taking drug and to notify prescriber at first sign of rash or other hypersensitivity reaction. Urge patient to report watery, bloody stools to prescriber immediately, even up to 2 months after drug therapy has ended.
Category
Chemical class: Fluoroquinolone
Therapeutic class: Antibiotic Pregnancy category: C
Indications
To reduce incidence or progression of inhalation anthrax after exposure to aerosolized Bacillus anthracis ,
IV:, Adults and children weighing more than 50 kg (110 lb). 500 mg (over 60 min for I.V. infusion) daily for 60 days. Children weighing less than 50 kg. 8 mg/kg (over 60 min for I.V. infusion) every 12 hr for 60 days. Maximum: 250 mg/dose. To treat acute maxillary sinusitis caused by Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae , IV
,
Adults. 500 mg daily (over 60 to 90 min for I.V. infusion) for 10 to 14 days. Or 759 mg daily for 5 days. To treat acute exacerbation of chronic bacterial bronchitis caused by H. influenzae, H. parainfluenzae, M. catarrhalis, S. pneumoniae, or Staphylococcus aureus , IV
,
Adults.500 mg daily (over 60 to 90 min for I.V. infusion) for 7 days. To treat community-acquired pneumonia caused by Chlamydia pneumoniae, H. influenzae, H. parainfluenzae, Klebsiella pneumoniae, Legionella pneumophila, M. catarrhalis, Mycoplasma pneumoniae, S. aureus, or S. pneumoniae , IV
,
Adults.500 mg daily (over 60 to 90 min for I.V. infusion) for 7 to 14 days. Alternatively, for infection caused by C. pneumoniae, H. influenzae, H. parainfluenzae, M. pneumoniae, or S. pneumoniae, 750 mg daily (over 60 to 90 min for I.V. infusion) for 5 days. To treat uncomplicated UTI caused by Escherichia coli, K. pneumoniae, or Staphylococcus saprophyticus levofloxacin 582 , IV
,
Adults. 250 mg daily (over 60 to 90 min for I.V. infusion) for 3 days. To treat complicated UTI caused by Enterococcus faecalis, E. cloacae, E. coli, K. pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa or acute pyelonephritis caused by E. coli , IV
,
Adults. 250 mg daily (over 60 to 90 min for I.V. infusion) for 10 days. To treat complicated UTI caused by E. coli, K. pneumoniae, or P. mirabilis or acute pyelonephritis caused by E. coli ,
IV:,
Adults. 750 mg daily (over 90 min for I.V. infusion) for 5 days. To treat mild to moderate skin and softtissue infections caused by S. aureus or Streptococcus pyogenes , IV
,
Adults. 500 mg daily (over 60 to 90 min for I.V. infusion) for 7 to 10 days. To treat complicated skin and soft-tissue infections caused by methicillin-sensitive Enterococcus faecalis, Proteus mirabilis, S. aureus, or S. pyogenes; to treat nosocomial pneumonia caused by S. aureus, Pseudomonas aeruginosa, Serratia marcescens, E. coli, K. pneumoniae, H. influenzae, or S. pneumoniae , IV
,
Adults.750 mg daily (over 60 to 90 min for I.V. infusion) for 7 to 14 days. To treat chronic bacterial prostatitis caused by E. coli, E. faecalis, or S. epidermidis , IV
,
Adults. 500 mg daily (over 60 to 90 min for I.V. infusion) for 28 days.
DOSAGE ADJUSTMENT For complicated UTI in patients with creatinine clearance of 10 to 19 ml/min/1.73 m2, 250 mg initially and then maintenance dosage of 250 mg every 48 hr. For complicated skin and softtissue infections and nosocomial pneumonia when creatinine clearance is 19 ml/ min/1.73 m2or less, 750 mg initially and then maintenance dosage of 500 mg every 48 hr; when creatinine clearance is 20 to 49 ml/min/1.73 m2, 750 mg initially and then maintenance dosage of 750 mg every 48 hr. For all other indications, when creatinine clearance is 19 ml/min/1.73 m2or less, 500 mg initially and then maintenance of 250 mg every 48 hr; when creatinine clearance is 20 to 49 ml/min/1.73 m2, 500 mg initially and then maintenance dosage of 250 mg every 24 hr. Mechanism of Action
Interferes with bacterial cell replication by inhibiting the bacterial enzyme DNA gyrase, which is essential for replication and repair of bacterial DNA. Contraindications
Hypersensitivity to levofloxacin, other fluoroquinolones, or their components Interactions
aluminum-, calcium-, or magnesium-containing antacids; didanosine; iron; sucralfate; zinc: Reduced GI absorption of levofloxacin antineoplastics: Decreased blood levofloxacin level
cimetidine: Increased blood levofloxacin level cyclosporine: Increased risk of nephrotoxicity
NSAIDs: Possibly increased CNS stimulation and risk of seizures oral anticoagulants: Increased anticoagulant effect and risk of bleeding oral antidiabetic : Possibly hyperglycemia or hypoglycemia
theophylline: Increased blood theophylline level and risk of toxicity sun exposure: Increased risk of photosensitivity Side Efect
CNS: Anxiety, CNS stimulation, dizziness, fever, headache, increased ICP, insomnia, light-headedness, nervousness, paranoia, peripheral neuropathy, psychosis, seizures, sleep disturbance, suicidal ideation
CV: Arrhythmias, leukocytoclastic vasculitis, prolonged QT interval, torsades de pointes, vasculitis, vasodilation
EENT: Blurred vision, decreased visual acuity, diplopia, dysphonia, scotoma, taste perversion, tinnitus
ENDO: Hyperglycemia, hypoglycemia
GI: Abdominal pain, acute hepatic necrosis or failure, anorexia, constipation, diarrhea, flatulence, hepatitis, hepatotoxicity, indigestion, jaundice, nausea, pseudomembranous levofloxacin 583 J K L colitis, vomiting
GU: Acute renal failure or insufficiency, crystalluria, interstitial nephritis, vaginal candidiasis
HEME: Agranulocytosis, aplastic anemia, eosinophilia, hemolytic anemia, leukopenia, pancytopenia, thrombocytopenia
MS: Arthralgia, back pain, myalgia, rhabdomyolysis, tendon or muscle rupture
RESP: Allergic pneumonitis
SKIN: Photosensitivity, pruritus, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria
Other: Anaphylaxis, angioedema, multiorgan failure, serum sickness Cautions
Use levofloxacin cautiously in patients with renal insufficiency. Monitor renal function as appropriate during treatment. Use drug cautiously in patients with CNS disorders, such as epilepsy, that may lower the seizure threshold. Also use cautiously in patients taking corticosteroids, especially elderly patients, because of increased risk of tendon rupture. Expect to obtain culture and sensitivity tests before levofloxacin treatment begins. Avoid giving drug within 2 hours of antacids. Give parenteral form over 60 to 90 minutes, depending on dosage, because bolus or rapid I.V. delivery may cause hypotension.
WARNING Stop levofloxacin at first sign of hypersensitivity, including rash and jaundice, because drug may lead to anaphylaxis. Reaction may occur after first dose. Expect to give epinephrine and provide supportive care. Monitor blood glucose level, especially in diabetic patient who takes an oral antidiabetic or uses insulin, because levofloxacin may alter blood glucose level. If so, notify prescriber, stop drug immediately if patient has hypoglycemia, and provide prescribed treatment. Monitor QT interval if needed. If it lengthens, notify prescriber at once and stop drug. Patients with hypokalemia, significant bradycardia, or cardiomyopathy and those receiving a class IA or III antiarrhythmic shouldn’t receive levofloxacin. Notify prescriber if patient has symptoms of peripheral neuropathy (pain; burning; tingling; numbness; weakness; altered sensations of light touch, pain, temperature, position sense, or vibration sense), which could be permanent; or CNS abnormalities (seizures, psychosis, increased ICP or CNS stimulation), which may lead to more serious Side Efect
, such as suicidal ideation. In each case, expect to discontinue levofloxacin. Watch for evidence of tendon rupture (inflammation, pain, swelling) during and up to several months after therapy, especially in children, elderly patients, patients receiving corticosteroids, and patients with kidney, heart, and lung transplants. Notify prescriber about suspected tendon rupture, and have patient rest and refrain from exercise until tendon rupture has been ruled out. If present, expect to provide supportive care, as ordered. Monitor patient’s bowel elimination. If diarrhea develops, obtain stool culture to check for pseudomembranous colitis. If confirmed, expect to stop drug and give fluid, electrolytes, and antibiotics effective against Clostridium difficile. PATIENT SAFTY
If patient will take oral solution form of levofloxacin, tell him to take it 1 hour before or 2 hours after eating. Advise patient to increase fluid intake during therapy to prevent crystalluria. Direct patient to take an antacid, didanosine, iron, sucralfate, or zinc at least 2 hours before or after levofloxacin. Tell patient to complete the drug as prescribed, even if symptoms subside. Urge patient to avoid excessive sun exposure and to wear sunscreen because of increased risk of photosensitivity. Tell patient to notify prescriber at first sign. Caution patient to avoid hazardous activities until drug’s CNS effects are known. Tell patient to stop drug and notify prescriber if he develops tendon pain or inflammation or abnormal changes in motor or sensory function. Urge patient to stop drug and tell prescriber about rash or other allergic reaction. Advise diabetic patient to monitor blood glucose level and reportchanges. Urge patient to tell prescriber about severe levofloxacin 584 diarrhea, even if it’s more than 2 months after drug therapy ends. Additional treatment may be needed. Advise patient to notify prescriber about heart palpitations or loss of consciousness. An ECG may be needed to detect adverse drug effects on the patient’s heart.
Category
Chemical class: Fluoroquinolone
Therapeutic class: Antibiotic Pregnancy category: C
Indications
To treat acute, uncomplicated cystitis caused by Escherichia coli or Klebsiella pneumoniae ,
IV:
Adults. 200 mg every 12 hr for 3 days. To treat uncomplicated cystitis caused by Citrobacter diversus, Enterobacter aerogenes, Proteus mirabilis, or Pseudomonas aeruginosa ,
IV:
Adults. 200 mg every 12 hr for 7 days. To treat complicated UTI caused by C. diversus, E. coli, K. pneumoniae, P. mirabilis, or P. aeruginosa
Adults. 200 mg every 12 hr for 10 days. To treat uncomplicated gonorrhea ,
IV: Adults and adolescents. 400 mg as single dose. To treat urethritis or cervicitis caused by Chlamydia trachomatis or Neisseria gonorrhoeae ,
IV: Adults and adolescents. 300 mg b.i.d. for 7 days as an alternative to doxycycline or azithromycin. To treat pelvic inflammatory disease caused by susceptible organisms Adults and adolescents. 400 mg b.i.d. with metronidazole P.O. for 10 to 14 days.
IV: Adults and adolescents. 400 mg every 12 hr with metronidazole I.V.; then switched to oral therapy, as prescribed, after 24 hr. Full course of therapy lasts 14 days. To treat prostatitis caused by E. coli ,
IV:
Adults. 300 mg every 12 hr for 6 wk. To treat lower respiratory tract infections caused by Haemophilus influenzae or Streptococcus pneumoniae and skin and soft-tissue infections caused by Staphylococcus aureus or Streptococcus pyogenes ,
IV:
Adults. 400 mg every 12 hr for 10 days.
DOSAGE ADJUSTMENT If creatinine clearance is 20 to 50 ml/min/1.73 m2, dosing interval possibly reduced to every 24 hr; if clearance is less than 10 ml/min/1.73 m2, dosage possibly reduced by 50% and given every 24 hr. Mechanism of Action
Inhibits synthesis of the bacterial enzyme DNA gyrase by counteracting excessive supercoiling of DNA during replication or transcription. Inhibition of DNA gyrase causes rapidand slow-growing bacterial cells to die. Incompatibilities
Don’t mix ofloxacin with other I.V. or additives. Contraindications
Hypersensitivity to ofloxacin, other fluoroquinolones, or their components Interactions
aluminum-, calcium-, or magnesiumcontaining antacids; didanosine; ferrous sulfate; magnesium-containing laxatives; multivitamins; sevelamer; sucralfate; zinc: Decreased absorption of oral ofloxacin probenecid: Decreased ofloxacin excretion, increased risk of toxicity procainamide: Decreased renal clearance of procainamide
warfarin: Possibly increased anticoagulant activity and risk of bleeding Side Efect
CNS: Aggressiveness, agitation, ataxia, dizziness, drowsiness, emotional lability, exacerbation of extrapyramidal disorders and myasthenia gravis, fever, headache, incoordination, insomnia, light-headedness, mania, peripheral neuropathy, psychotic reactions, restlessness, stroke, suicidal ideation, syncope
CV: Arrhythmias, prolonged QT interval, severe hypotension, torsades de pointes, vasculitis
EENT: Blurred vision; diplopia; disturbances in taste, smell, hearing, and equilibrium
ENDO: Hyperglycemia, hypoglycemia
GI: Abdominal cramps or pain, acute hepatic necrosis or failure, diarrhea, hepatitis, jaundice, nausea, pseudomembranous colitis, vomiting
GU: Acute renal insufficiency or failure, interstitial nephritis, renal calculi, vaginal candidiasis
HEME: Agranulocytosis, aplastic or hemolytic anemia, leukopenia, pancytopenia, thrombocytopenia
MS: Arthralgia; myalgia; rhabdomyolysis; tendinitis; tendon inflammation, pain, or rupture
RESP: Allergic pneumonitis, pulmonary edema
SKIN: Blisters, diaphoresis, erythema, erythema multiforme, exfoliative dermatitis, photosensitivity, pruritus, rash, StevensJohnson syndrome, toxic epidermal necrolysis, urticaria
Other: Acidosis, anaphylaxis, infusion site phlebitis, serum sickness Cautions
Because of increased risk of prolonged QT interval, ofloxacin shouldn’t be used if patient has had a prolonged QT interval, has an uncorrected electrolyte disorder, or takes a Class IA or III antiarrhythmic. Monitor elderly patients closely because risk of prolonged QT interval may be increased in this group. For I.V. infusion, dilute drug in normal saline solution or D5W to at least 4 mg/ ml, and infuse over 60 minutes to minimize the risk of hypotension. Discard unused portion. Monitor patient closely for hypersensitivity, which may occur as early as first dose. Reaction may include angioedema, bronchospasm, dyspnea, itching, rash, jaundice, shortness of breath, and urticaria. If these signs or symptoms appear, notify prescriber immediately and expect to discontinue drug. Notify prescriber if patient has symptoms of peripheral neuropathy (pain, burning, tingling, numbness, weakness, or altered sensations of light touch, pain, temperature, position sense, or vibration sense), which could be permanent; tendon rupture (pain and inflammation), which may occur more often in patients (especially elderly ones) taking corticosteroids and requires immediate rest; or a severe photosensitivity reaction. In each case, expect to stop ofloxacin. Maintain adequate hydration to prevent development of highly concentrated urine and crystalluria. Expect an increased risk of toxicity in severe hepatic disease, including cirrhosis. Be aware that ofloxacin may stimulate the CNS and aggravate seizure disorders. If diarrhea develops, notify prescriber because it may indicate pseudomembranous colitis. Ofloxacin may need to be discontinued and additional therapy started. Be alert for secondary fungal infection. PATIENT SAFTY
Encourage patient to take each oral dose with a full glass of water. Tell patient to complete full course of ofloxacin therapy exactly as prescribed, even if he feels better before it’s complete. Urge patient not to take antacids, iron or zinc preparations, or other (such as sucralfate and didanosine), within 2 hours of ofloxacin to prevent decreased or delayed drug absorption. Advise patient to avoid hazardous activities until CNS effects of drug are known. Tell patient to limit exposure to sun and ultraviolet light to prevent phototoxicity. Advise patient to notify prescriber immediately about burning skin, hives, itching, rash, rapid heart rate, abnormal motor or sensory function, and tendon pain. Urge patient to seek medical care immediately for trouble breathing or swallowing, which may signal an allergic reaction. Instruct diabetic patient who takes insulin or an antidiabetic to notify prescriber immediately if he develops a hypoglycemic reaction; ofloxacin will have to be stopped. Advise patient to notify prescriber if diarrhea develops, even up to 2 months after ofloxacin therapy ends. Additional therapy may be needed.
Trade Name & Company Name
effect of Ofloxacin in Pregnancy, Fetal Health
and Breast feeding
Pregnancy
. There are no adequate reports or well-controlled studies in pregnant women. Ofloxacin achieves high tissue penetration. It is not effective prophylaxis for infection after therapeutic abortion; doxycycline is preferred. The FDA has added a black box warning covering the potential for tendon rupture. Fetal Health
There are no adequate reports or well-controlled studies in human fetuses. Less than 4% of maternal ofloxacin crosses the isolated perfused human placenta, though clearance is such that potentially therapeutic levels in AF and sera make it a candidate for fetal therapy if otherwise safe. In humans, fluoroquinolones are not associated with an increased risk of malformation. Neither ophthalmic nor otic application results in significant systemic drug levels. In general, rodent studies are reassuring, though some rodent models using otic application revealed minor skeletal abnormalities and IUGR. The administration of very high multiples of the MRHD is associated with fetal toxicity. 812 Breastfeeding
There are no adequate reports or well-controlled studies in nursing women. Ofloxacin achieves an M:P ratio of ?1 but is consistently lower than ciprofloxacin. Serum and milk were obtained from 10 women simultaneously at 2, 4, 6, 9, 12, and 24h after ofloxacin. The mean breast milk levels were 2.4, 1.9, 1.3, 0.6, 0.3, and 0.05mcg/ml, respectively. Even with 100% oral absorption, Breastfeeding mothers who take ofloxacin will expose their infants to ofloxacin concentrations below that being studied in the pediatric population. Pregnancy
. Levofloxacin is indicated for the treatment of mild, moderate, and severe infections caused by a wide variety of susceptible microorganisms. There are no adequate reports or well-controlled studies of levofloxacin in pregnant women. Compared to other quinolones, levofloxacin has fewer adverse GI or CNS events and is minimally phototoxic. Levofloxacin should not be used for the treatment of gonorrhea because of the growing prevalence of resistant strains. Recent studies report increased sensitivity of Chlamydia trachomatis to quinolone medication. Vaginal candidiasis is more frequently associated with quinolone use than with other antibiotics. 583 Fetal Health
There are no adequate reports or well-controlled studies in human fetuses. Less than 4% of maternal levofloxacin and ofloxacin crosses the isolated perfused human placenta. Intracompartmental clearance has not been detailed to date. Animal studies (mice, dogs, rabbits) reveal that several quinolones are associated with a juvenile arthropathy, and it is this toxicity that has lead to their restricted use in pregnant women. However, not all quinolones have the same potency on cartilage growth. Further, the use of quinolones during the 1st trimester of human Pregnancy
has not been associated with an increased risk of malformations or musculoskeletal conditions. Rodent studies with levofloxacin are reassuring, revealing no evidence of teratogenicity despite the use of doses higher than those used clinically. IUGR was noted. Breastfeeding
At steady state, peak levofloxacin exposure in breast milk approximates 8mcg/ml 5h after dosing. Elimination pharmacokinetics followed the anticipated pattern. Thus, peak levofloxacin concentrations in human breast milk are similar to levels attained in plasma. However, Breastfeeding mothers who take levofloxacin will expose their infants to levofloxacin in concentrations below those being studied in the pediatric population. Pregnancy
. Fluoroquinolone therapy is widely used as a treatment for gonorrhea because it is a relatively inexpensive, oral, and single- dose therapy. However, fluoroquinolone-resistant disease is being identified more frequently. A test for cure is essential. There are no adequate reports or well-controlled studies in pregnant women. Ciprofloxacin is also usually selected when penicillin- class agents have no effect on gram-negative rods. Ciprofloxacin has the best safety profile of second-line drugs for drug-resistant tuberculosis. It is the drug of choice for prophylaxis among asymptomatic pregnant women exposed to B. anthracis. In instances where the strain is penicillin-sensitive, prophylaxis with amoxicillin, 500mg tid ?60d, may be considered. Isolates of B. anthracis implicated in the recent bioterrorist attacks are susceptible to penicillin in laboratory tests, but may contain penicillinase activity. Penicillins are not recommended for 204 treatment of anthrax. Ciprofloxacin has also been used to treat Q fever during pregnancy. Fetal Health
There are no adequate reports or well-controlled studies in human fetuses. Ciprofloxacin crosses the human placenta, and can be found in AF in low quantities. The mean transplacental transfer percentage of ciprofloxacin across the isolated perfused human cotyledon approximates 3.2% and the transplacental transfer index (the ratio of transplacental transfer between ciprofloxacin and antipyrine) was 0.34. Short-duration treatment with ciprofloxacin appears free of adverse fetal responses. As a class, the new quinolones do not appear associated with an increased risk of malformation or musculoskeletal problems in humans. The effect of prolonged exposure such as that required for Crohn?s disease or anthrax prophylaxis remains unknown. Longer follow-up and MRI of the joints may be warranted to exclude subtle cartilage and bone damage. There are no clinically significant musculoskeletal dysfunctions reported in children exposed to fluoroquinolones in utero. Treatment of fetal mice, dogs, and rabbits with other quinolones is associated with an acute arthropathy of the weight-bearing joints. Breastfeeding
There are no adequate reports or well-controlled studies in lactating human mothers. Ciprofloxacin enters human breast milk, and oral doses of this drug are concentrated in breast milk at levels higher than serum. C. difficile pseudomembranous colitis has been reported in a breastfed neonate whose mother was taking ciprofloxacin. In some animals, slow ciprofloxacin elimination results in blood levels out of proportion to that ingested. Though the American Academy of Pediatrics considers it safe for Breastfeeding women, it is probably best to avoid ciprofloxacin when there are reasonable alternatives.
the follwing drugs will increse Ofloxacin by inhepiting cyp450
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the follwing drugs will decrease Ofloxacin by inhancing cyp450
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trad drugs based on Ofloxacin
| Gen name | Trade name | Catagory name |
| ciprofloxacin | Cetraxal | Otic anti-infectives |
| ciprofloxacin | Ciloxan | Ophthalmic anti-infectives |
| ciprofloxacin | Cipro | Quinolones |
| ciprofloxacin | Cipro I.V. | Quinolones |
| ciprofloxacin | Cipro XR | Quinolones |
| ciprofloxacin | Otiprio | Otic anti-infectives |
| ciprofloxacin | Proquin XR | Quinolones |
| ciprofloxacin / dexamethasone | Ciprodex | Otic steroids with anti-infectives |
| ciprofloxacin / fluocinolone | Otovel | Otic steroids with anti-infectives |
| ciprofloxacin / hydrocortisone | Cipro HC | Otic steroids with anti-infectives |
| levofloxacin | Iquix | Ophthalmic anti-infectives |
| levofloxacin | Levaquin | Quinolones |
| levofloxacin | Quixin | Ophthalmic anti-infectives |
| ofloxacin | Floxin | Quinolones |
| ofloxacin | Floxin Otic | Otic anti-infectives |
| ofloxacin | Ocuflox | Ophthalmic anti-infectives |
| Levofloxacin | LEVONIC 500MG-100ML SOLUTION FOR IV INFUSION | |
| Levofloxacin | TAVANIC 250MG FC TAB | |
| Levofloxacin | TAVANIC 5 MG -1 ML SOLUTION IV INFUSION | |
| Levofloxacin | TAVANIC 500MG FC TAB | |
| Ofloxacin | DEXAFLOX OPHTHALMIC SUSPENSION | |
| Ofloxacin | EYLOX 0.3% EYE DROPS | |
| Ofloxacin | JEDCOFLOCIN 200MG TABLETS | |
| Ofloxacin | LOXTRA EYE DROP | |
| Ofloxacin | OFLACIN 200MG TAB | |
| Ofloxacin | OFLOX 0.3% EYE DROPS | |
| Ofloxacin | OPTIFLOX OPTHALMIC SOLUTION | |
| Ofloxacin | OXACIN | |
| Ofloxacin | TARIVID 200MG FC TAB | |
| Ofloxacin | TARIVID I.V2MG-MLSOLUTION FOR INFUSION | |
other drugs from same cataogory