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Ofloxacin

Pronunciation

Class: Quinolones
VA Class: AM900
Chemical Name: ± - 9 - Fluoro - 2,3 - dihydro - 3 - methyl - 10 - (4 - methyl - 1 - piperazinyl) - 7 - oxo - 7H - pyrido[1,2,3 - de] - 1,4 - benzoxaz ine-6-carboxylicacid
CAS Number: 82419-36-1

Warning(s)

  • Systemic fluoroquinolones, including ofloxacin, are associated with an increased risk of tendinitis and tendon rupture in all age groups.1 675 676 680 Risk of fluoroquinolone-associated tendinitis and tendon rupture is further increased in older adults (usually those >60 years of age), individuals receiving concomitant corticosteroids, and kidney, heart, or lung transplant recipients.1 675 676 680 (See Tendinopathy and Tendon Rupture under Cautions.)

  • Fluoroquinolones, including ofloxacin, may exacerbate muscle weakness in patients with myasthenia gravis.1 Avoid in patients with known history of myasthenia gravis.1

Introduction

Antibacterial; fluoroquinolone.1 2 3 5 420 442 464 634 636

Uses for Ofloxacin

Bone and Joint Infections

Treatment of mild to moderate bone and joint infections (including osteomyelitis) caused by susceptible Escherichia coli,233 252 262 263 491 Enterobacter,233 252 262 263 Klebsiella oxytoca,491 K. pneumoniae,233 252 263 Proteus mirabilis,252 262 Pseudomonas aeruginosa,233 252 262 263 414 491 502 Serratia,233 252 491 Staphylococcus aureus,233 252 262 263 413 414 491 502 or S. epidermidis.233 252 262 263 414 491 Consider that fluoroquinolone-resistant staphylococci have been reported with increasing frequency; probably should not be used alone in treatment of bone and joint infections known or suspected of being caused by staphylococci.502

GI Infections

Treatment of infectious diarrhea caused by susceptible enterotoxigenic E. coli or Shigella.330 420 429 Active in vitro against most pathogens associated with infectious diarrhea (including E. coli, Shigella, Salmonella, Aeromonas, Vibrio, Yersinia enterocolitica, Campylobacter); may be a drug of choice for empiric treatment.242 243 321 327 426 429 539 Consider increasing emergence of fluoroquinolone-resistant Campylobacter secondary to widespread use of the drugs; use judiciously for treatment or prevention of enteropathogenic diarrhea.524 539 541

Treatment of shigellosis caused by susceptible Shigella when anti-infectives indicated.461 Anti-infectives generally indicated in addition to fluid and electrolyte replacement for treatment of patients with severe shigellosis, dysentery, or underlying immunosuppression.292 412 Empiric treatment regimen can be used initially, but in vitro susceptibility testing indicated since resistance is common.292 Fluoroquinolones (e.g., ciprofloxacin, levofloxacin, moxifloxacin) are drugs of choice when susceptibility of isolate unknown or ampicillin- or co-trimoxazole-resistant strains involved.292 412 461 566

Treatment of travelers’ diarrhea.305 525 557 590 612 If caused by bacteria, may be self-limited and resolve within 3–5 days without anti-infective treatment;525 588 589 590 if diarrhea is moderate or severe, persists for >3 days, or is associated with fever or bloody stools, short-term (1–3 days) anti-infective treatment is recommended.305 525 588 589 590 Fluoroquinolones (ciprofloxacin, levofloxacin, norfloxacin, ofloxacin) usually drugs of choice when treatment, including self-treatment, indicated.305 525 588 590 612 Azithromycin is a treatment alternative if fluoroquinolones should not be used (e.g., children, pregnant women) and a drug of choice for travelers in areas with a high prevalence of fluoroquinolone-resistant Campylobacter (e.g., South and Southeast Asia) or when there is no response after 48 hours of fluoroquinolone treatment.305 525 Rifaximin is another alternative for treatment of travelers' diarrhea caused by noninvasive E. coli.305 525

Prevention of travelers’ diarrhea in individuals traveling for relatively short periods to areas where enterotoxigenic E. coli and other causative bacterial pathogens (e.g., Shigella) are known to be susceptible to the drug.305 525 CDC and others do not recommend anti-infective prophylaxis in most individuals traveling to areas of risk;305 524 525 527 529 the principal preventive measures are prudent dietary practices.525 If anti-infective prophylaxis is used (e.g., in immunocompromised individuals such as those with HIV infection), a fluoroquinolone (ciprofloxacin, levofloxacin, ofloxacin, norfloxacin) is recommended for nonpregnant adults;305 525 azithromycin and rifaximin are alternatives.305 Weigh use of anti-infective prophylaxis against use of prompt, early self-treatment with anti-infectives, a strategy that can limit duration of illness to 6–24 hours in most cases.525

Treatment of >Helicobacter pylori infection and duodenal ulcer disease in conjunction with other agents.406 643 Additional study is needed and some clinicians state that efficacy of dual or triple therapy that includes a fluoroquinolone anti-infective currently is unproven for H. pylori infections.539 570

Respiratory Tract Infections

Treatment of acute bacterial exacerbations of chronic bronchitis caused by susceptible Haemophilus influenzae1 230 232 236 239 244 251 253 259 265 272 274 413 414 420 433 or Streptococcus pneumoniae.1 230 232 239 244 251 253 259 265 272 274 414 420

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Treatment of mild to moderate community-acquired pneumonia (CAP) caused by susceptible H. influenzae1 230 232 236 251 253 259 272 413 414 420 or S. pneumoniae.1 230 232 251 253 259 272 414 420 IDSA and ATS state that other fluoroquinolones with enhanced activity against S. pneumoniae (gemifloxacin, levofloxacin, moxifloxacin) are drugs of choice for empiric treatment of CAP in outpatients at risk for infections caused by drug-resistant S. pneumoniae (DRSP) and also are drugs of choice for empiric treatment of CAP in inpatients.639

Has been used for treatment of respiratory tract infections caused by susceptible Moraxella catarrhalis,236 239 244 251 272 433 S. aureus,232 236 244 265 414 420 viridans streptococci,484 Enterobacteriaceae,230 232 251 259 265 414 420 484 or Ps. aeruginosa.230 232 239 259 265 268 414 420

Has been used for treatment of acute exacerbations of bronchopulmonary Ps. aeruginosa infections in adults with cystic fibrosis.126 170 177 264 413 420 464 As with other anti-infectives, Ps. aeruginosa may be cleared temporarily from the sputum, but a bacteriologic cure rarely is obtained and should not be expected.177 249 264 413

Should not be used alone for empiric therapy in aspiration pneumonia since these infections generally involve anaerobic bacteria.243 253 259 541

Skin and Skin Structure Infections

Treatment of mild to moderate uncomplicated skin and skin structure infections (e.g., cellulitis, subcutaneous abscesses, surgical wound infections, furunculosis, folliculitis) caused by susceptible S. aureus,1 255 420 462 S. epidermidis,420 S. pyogenes (group A β-hemolytic streptococci),1 or P. mirabilis;1 also has been used for treatment of skin and skin structure infections caused by susceptible E. coli255 or Ps. aeruginosa.255

The increasing emergence of fluoroquinolone resistance in staphylococci limits usefulness of the drug for infections caused by these gram-positive bacteria.40 133 134 413 426 506 519 520 521 522 539 541

Urinary Tract Infections (UTIs) and Prostatitis

Treatment of uncomplicated cystitis caused by susceptible Citrobacter diversus,1 288 425 E. aerogenes,1 288 E. coli,1 277 278 280 282 288 423 478 490 K. pneumoniae,1 280 288 490 P. mirabilis,1 277 278 280 288 423 490 or Ps. aeruginosa;1 280 288 478 also has been used for cystitis caused by susceptible C. freundii,490 E. cloacae,490 or Morganella morganii.280

Has been used treatment of uncomplicated UTIs caused by susceptible gram-positive bacteria, including S. aureus,282 288 423 490 S. epidermidis,277 278 423 490 S. saprophyticus,277 282 423 478 Enterococcus faecalis,277 278 288 490 viridans streptococci,490 or Streptococcus agalactiae (group B streptococci).278 Because of concerns about emergence of fluoroquinolone resistance in gram-positive bacteria (e.g., staphylococci), such use should be selective.40 133 134 406 506 519 520 521 522 539 541

Treatment of complicated UTIs caused by susceptible C. diversus,1 285 E. coli,1 279 281 285 K. pneumoniae,1 285 P. mirabilis,1 285 or Ps. aeruginosa;1 279 281 285 also has been used for complicated UTIs caused by susceptible C. freundii,285 Enterobacter,285 M. morganii,285 or P. rettgeri.285

Treatment of recurrent UTIs and chronic prostatitis in men caused by susceptible E. coli.1 284 285 286 288 May be a drug of choice because high concentrations are attained in prostatic tissue.284 424

Usually reserved for treatment of complicated UTIs, especially those caused by multidrug-resistant bacteria.237 241 243 275 282 417 426 Generally considered alternative for treatment of uncomplicated UTIs (e.g., acute cystitis) and used in these infections only when other urinary anti-infectives likely to be ineffective or cannot be used.143 237 241 243 275 282 283 426

Anthrax

Alternative for postexposure prophylaxis following suspected or confirmed exposure to aerosolized anthrax spores (inhalational anthrax) when oral ciprofloxacin and oral doxycycline are not available.620

Alternative for treatment of inhalational anthrax when a parenteral regimen is not available (e.g., supply or logistic problems because large numbers of individuals require treatment in a mass casualty setting).620 A multiple-drug parenteral regimen (ciprofloxacin or doxycycline and 1 or 2 other anti-infectives predicted to be effective) is preferred for initial treatment of inhalational anthrax that occurs as the result of exposure to anthrax spores in the context of biologic warfare or bioterrorism.620 483

Brucellosis

Treatment of brucellosis caused by Brucella canis, B. abortus, or B. melitensis; used with or without rifampin.243 417 439 561

Chlamydial Infections

Alternative for treatment of urogenital chlamydial infections.319 CDC and others recommend azithromycin or doxycycline as drugs of choice;319 328 erythromycin,319 328 ofloxacin,319 or levofloxacin319 328 are alternatives.

Gonorrhea and Associated Infections

Has been used for treatment of acute, uncomplicated urethral, endocervical, or rectal gonorrhea or for follow-up treatment of disseminated gonococcal infections caused by susceptible Neisseria gonorrhoeae.1 289 290 291 294 296 300 486 487 500

Treatment of acute epididymitis.319 328 CDC recommends an initial regimen of IM ceftriaxone and oral doxycycline in all patients;319 additional therapy includes ofloxacin or levofloxacin, but fluoroquinolones should be used alone only when epididymitis is most likely caused by sexually transmitted enteric bacteria (e.g., E. coli) or when nucleic acid amplification test (NAAT) is negative for N. gonorrhoeae.319 328

Because quinolone-resistant N. gonorrhoeae (QRNG) is widely disseminated worldwide, including in the US319 328 642 671 673 (see Resistance in Neisseria gonorrhoeae under Cautions), CDC and others no longer recommend ofloxacin for treatment of gonorrhea or any associated infections that may involve N. gonorrhoeae (e.g., pelvic inflammatory disease [PID], epididymitis).319 328 671 673

Legionnaires’ Disease

Treatment of Legionnaires’ disease caused by Legionella pneumophila.564

Mycobacterial Infections

Alternative for use in multiple-drug regimens for treatment of active tuberculosis.94 104 417 420 456 464 545 563 638

CDC, ATS, and IDSA state that use of fluoroquinolones can be considered in patients with relapse, treatment failure, or Mycobacterium tuberculosis resistant to isoniazid and/or rifampin or when first-line drugs cannot be tolerated.638 There have been recent reports of extensively drug-resistant tuberculosis (XDR tuberculosis).645 646 XDR tuberculosis is caused by M. tuberculosis resistant to rifampin and isoniazid (multiple-drug resistant strains) that also are resistant to a fluoroquinolone and at least one parenteral second-line antimycobacterial (capreomycin, kanamycin, amikacin).645 646

Although there is clinical experience with several fluoroquinolones in the treatment of tuberculosis (e.g., ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin),456 563 638 647 653 655 656 657 658 levofloxacin and moxifloxacin are the fluoroquinolones recommended by CDC, ATS, and IDSA and levofloxacin may be preferred on the basis of cumulative experience.638 The most recent CDC, ATS, and IDSA recommendations for treatment of tuberculosis should be consulted for more specific information.638

Alternative for use in multiple-drug regimens for treatment of multibacillary leprosy.566 613 617 WHO recommends ofloxacin as an alternative for multibacillary leprosy regimens in patients who will not accept or cannot tolerate clofazimine566 613 617 and when rifampin cannot be used because of adverse effects, intercurrent disease (e.g., chronic hepatitis), or infection with rifampin-resistant Mycobacterium leprae.613 617

Component of a single-dose rifampin-based multiple-drug regimen (ROM) for treatment of single-lesion paucibacillary leprosy (i.e., a single skin lesion with definite loss of sensation but without nerve trunk involvement).613 614 617 618 619

Treatment of postoperative sternotomy wound or soft tissue infections caused by M. fortuitum.256 317 332 333 479 Also has been used for treatment of M. fortuitum pulmonary infections104 332 479 or UTIs.489 ATS and IDSA recommend that M. fortuitum pulmonary infections be treated with a regimen consisting of at least 2 anti-infectives selected based on results of in vitro susceptibility testing and tolerability (e.g., amikacin, ciprofloxacin or ofloxacin, a sulfonamide, cefoxitin, imipenem, doxycycline).674

Nongonococcal Urethritis and Cervicitis

Treatment of nongonococcal urethritis and cervicitis caused by susceptible Chlamydia trachomatis.1 243 287 293 295 297 298 299 300 301 302 307 308 309 311 312 319 328 413 426 436 447 449 450 488 503

CDC and others recommend azithromycin or doxycycline as drugs of choice;319 328 erythromycin,319 ofloxacin,319 or levofloxacin319 328 are alternatives.

Pelvic Inflammatory Disease

Has been used for treatment of acute PID caused by susceptible C. trachomatis or N. gonorrhoeae.1 319 328 Do not use in any infections that may involve N. gonorrhoeae.319 328 671 673 (See Resistance in Neisseria gonorrhoeae under Cautions.)

When an oral regimen used for treatment of mild to moderately severe acute PID, CDC recommends a single IM dose of ceftriaxone, cefoxitin (with oral probenecid), or cefotaxime given in conjunction with oral doxycycline (with or without oral metronidazole).319 Although fluoroquinolones no longer recommended for PID, if a parenteral cephalosporin is not feasible, a regimen of oral levofloxacin or oral ofloxacin given with or without oral metronidazole may be considered if the community prevalence and individual risk of gonorrhea are low.319

Plague

Alternative for treatment of plague caused by Yersinia pestis, including naturally occurring plague and plague that occurs following exposure to Y. pestis in the context of biologic warfare or bioterrorism.628 629 Regimen of choice is streptomycin (or gentamicin) with or without doxycycline;292 628 629 alternatives are doxycycline, chloramphenicol (drug of choice for plague meningitis), fluoroquinolones, or co-trimoxazole (may be less effective than other alternatives).292 566 628 629

Postexposure prophylaxis following a high risk exposure to Y. pestis (e.g., household, hospital, or other close contact with an individual who has pneumonic plague; laboratory exposure to viable Y. pestis; confirmed exposure in the context of biologic warfare or bioterrorism).628 629 Drugs of choice for such prophylaxis are doxycycline (or tetracycline) or a fluoroquinolone (e.g., ciprofloxacin, levofloxacin, ofloxacin); chloramphenicol is an alternative.628 629

Rickettsial Infections

Alternative to tetracyclines for treatment of rickettsial infections.325 326 560 566 Has been used for treatment of acute Q fever pneumonia caused by Coxiella burnetii325 560 and Mediterranean spotted fever caused by Rickettsia conorii.326 Has been used in conjunction with doxycycline for long-term treatment of Q fever endocarditis,490 560 but may be less effective than a regimen of doxycycline and hydroxychloroquine.490

Typhoid Fever and Other Salmonella Infections

Treatment of typhoid fever (enteric fever) caused by susceptible Salmonella typhi, including chloramphenicol-resistant strains.318 320 331 429 481 492

Treatment of chronic typhoid carriers.413 421

Treatment of gastroenteritis caused by Salmonella.420

Selective Decontamination of the GI Tract

Selective decontamination of the GI tract in granulocytopenic patients.429 482

Ofloxacin Dosage and Administration

Administration

Oral Administration

Administer orally.1 417 427 464

May be given without regard to meals.1 Presence of food in the GI tract can decrease the rate and/or extent of absorption of ofloxacin; not usually considered clinically important.1 176 189 420 464 649 650 651 Milk and yogurt do not appear to affect GI absorption.649 650 (See Pharmacokinetics.)

Patients should be well hydrated and should be instructed to drink fluids liberally to avoid formation of highly concentrated urine.1

Dosage

Pediatric Patients

Mycobacterial Infections
Single-lesion Paucibacillary Leprosy
Oral

Children 5–14 years of age: WHO recommends a single-dose ROM regimen that includes a single 300-mg dose of rifampin, a single 200-mg dose of ofloxacin, and a single 50-mg dose of minocycline.615

Children <5 years of age: WHO recommends that an appropriately adjusted dose of each drug in the above single-dose ROM regimen be used.615

Adults

General Adult Dosage
Oral

200–400 mg every 12 hours.1

Duration of treatment depends on the type and severity of infection and should be determined by clinical and bacteriologic response of the patient.344

GI Infections
Treatment of Travelers’ Diarrhea
Oral

300 mg twice daily for 1–3 days.305 557

Prevention of Travelers’ Diarrhea
Oral

300 mg once daily during the period of risk.305 588 589 612

Although anti-infective prophylaxis generally discouraged,305 525 some clinicians state it can be given during period of risk (for ≤3 weeks) beginning day of travel and continuing for 1 or 2 days after leaving area of risk.588 589 612

Respiratory Tract Infections
Acute Bacterial Exacerbations of Chronic Bronchitis
Oral

400 mg every 12 hours for 10 days.1

Community-acquired Pneumonia
Oral

400 mg every 12 hours for 10 days.1

Skin and Skin Structure Infections
Uncomplicated Infections
Oral

400 mg every 12 hours for 10 days.1

Urinary Tract Infections (UTIs) and Prostatitis
Uncomplicated Cystitis Caused by E. coli or K. pneumoniae
Oral

200 mg every 12 hours for 3 days.1

Uncomplicated Cystitis Caused by Other Susceptible Bacteria
Oral

200 mg every 12 hours for 7 days.1

Complicated UTIs
Oral

200 mg every 12 hours for 10 days.1

Prostatitis Caused by E. coli
Oral

300 mg every 12 hours for 6 weeks1 or longer.284 285

Anthrax
Postexposure Prophylaxis Following Exposure in the Context of Biologic Warfare or Bioterrorism
Oral

400 mg twice daily620 for ≥60 days.620 621

Optimum duration of postexposure prophylaxis after an inhalation exposure to B. anthracis spores is unclear,554 628 but prolonged postexposure prophylaxis usually required.620 628 A duration of 60 days may be adequate for a low-dose exposure, but a duration >4 months may be necessary to reduce the risk following a high-dose exposure.554 CDC, US Working Group on Civilian Biodefense, and US Army Medical Research Institute of Infectious Diseases (USAMRIID) recommend that postexposure prophylaxis in unvaccinated individuals be continued for ≥60 days following a confirmed exposure (including in laboratory workers with confirmed exposures to B. anthracis cultures).532 620 621 628 The USPHS Advisory Committee on Immunization Practices (ACIP) and USAMRIID recommend that individuals who are partially or fully vaccinated against anthrax receive postexposure prophylaxis for ≥30 days;522 628 if given in conjunction with anthrax vaccine, continue prophylaxis for at least 7–14 days after the third vaccine dose.533 628

Treatment of Inhalational Anthrax in a Mass Casualty Setting
Oral

400 mg twice daily for ≥60 days.620

Brucellosis
Oral

400 mg once daily in conjunction with oral rifampin (600 mg once daily) given for 6 weeks was effective in some patients.561

Chlamydial Infections
Urogenital Infections
Oral

300 mg every 12 hours for 7 days.1 301 307 309 319

Gonorrhea and Associated Infections
Uncomplicated Urethral, Endocervical, or Rectal Gonorrhea
Oral

400 mg as a single dose has been used for infections caused by susceptible Neisseria gonorrhea.1 290 291 448 500

Not recommended by CDC or others for treatment of gonorrhea or any associated infections that may involve N. gonorrhoeae (e.g., PID, epididymitis).319 328 671 673 (See Gonorrhea and Associated Infections under Uses.)

Epididymitis
Oral

300 mg every 12 hours for 10 days recommended by CDC and others.319 328

Use only when epididymitis most likely caused by sexually transmitted enteric bacteria (e.g., E. coli) or when NAAT negative for N. gonorrhoeae.319 328 (See Resistance in Neisseria gonorrhoeae under Cautions.)

Legionnaires’ Disease
Oral

400 mg every 12 hours for 2–3 weeks.564

Mycobacterial Infections
Leprosy
Oral

Treatment of multibacillary leprosy in adults who cannot receive rifampin because of adverse effects, intercurrent disease (e.g., chronic hepatitis), or infection with rifampin-resistant Mycobacterium leprae: WHO recommends supervised administration of a regimen of clofazimine (50 mg daily), ofloxacin (400 mg daily), and minocycline (100 mg daily) given for 6 months, followed by a regimen of clofazimine (50 mg daily) and minocycline (100 mg daily) given for at least an additional 18 months.613 616 617 618

Treatment of multibacillary leprosy in adults who will not accept or cannot tolerate clofazimine:104 108 WHO recommends supervised administration of a once-monthly ROM regimen that includes rifampin (600 mg once monthly), ofloxacin (400 mg once monthly), and minocycline (100 mg once monthly) given for 24 months.613 617

Treatment of single-lesion paucibacillary leprosy in certain patient groups: WHO recommends a single-dose ROM regimen that includes a single 600-mg dose of rifampin, a single 400-mg dose of ofloxacin, and a single 100-mg dose of minocycline.613 617

M. fortuitum Infections
Oral

Treatment of postoperative sternotomy wound or soft tissue infections: 300 mg once daily or 1.2 g daily in 3 or 4 divided doses has been given for 3–6 months in conjunction with amikacin (usually 250 mg IM or IV twice daily for 4–8 weeks).256

Treatment of pulmonary infections: ATS and IDSA recommend a regimen consisting of at least 2 anti-infectives (see Mycobacterial Infections under Uses) given for at least 12 months after negative sputum cultures are attained.674

Treatment of serious skin, bone, or soft tissue infections: ATS and IDSA recommend a regimen consisting of at least 2 anti-infectives (see Mycobacterial Infections under Uses)given for at least 4 months for infections involving skin or soft tissue or 6 months for those involving bone.674

Nongonococcal Urethritis and Cervicitis
Oral

300 mg every 12 hours for 7 days.1 301 307 309 319 447 488

Pelvic Inflammatory Disease
Oral

400 mg every 12 hours for 10–14 days recommended by manufacturer.1 CDC recommends 400 mg twice daily for 14 days with or without oral metronidazole (500 mg twice daily for 14 days).319

Use only when cephalosporins not feasible, community prevalence and individual risk of gonorrhea is low, and in vitro susceptibility confirmed.319 (See Pelvic Inflammatory Disease under Uses.)

Rickettsial Infections
Mediterranean Spotted Fever
Oral

200 mg every 12 hours for 7 days was effective in some patients.326

Q Fever
Oral

Acute Q fever pneumonia caused by Coxiella burnetii: 600 mg daily for up to 16 days has been used.560

Q fever endocarditis: 200 mg 3 times daily in conjunction with oral doxycycline (100 mg twice daily); long-term treatment (≥4 years) may be required.460

Typhoid Fever and Other Salmonella Infections
Mild to Moderate Typhoid Fever
Oral

200–400 mg every 12 hours for 7–14 days.318 320 331 429 481 492

Special Populations

Hepatic Impairment

Maximum dosage of 400 mg daily in those with severe hepatic impairment (e.g., cirrhosis with or without ascites).1

Renal Impairment

Dosage adjustments required in adults with Clcr ≤50 mL/minute.1 182 220 223 224 225

Dosage in Adults with Renal Impairment

Clcr (mL/min)

Dosage

20–50

Usual initial dose, then usual dose once every 24 hours1

<20

Usual initial dose, then 50% of usual dose once every 24 hours1

Hemodialysis Patients

Initial 200-mg dose, then 100 mg once daily;222 431 supplemental doses not required after dialysis222 223

Geriatric Patients

No dosage adjustments except those related to renal impairment.1 (See Renal Impairment under Dosage and Administration.)

Cautions for Ofloxacin

Contraindications

  • Known hypersensitivity to ofloxacin or other quinolones.1

Warnings/Precautions

Warnings

Tendinopathy and Tendon Rupture

Fluoroquinolones, including ofloxacin, are associated with increased risk of tendinitis and tendon rupture in all age groups.1 675 676 680 This risk is further increased in older adults (usually those >60 years of age), individuals receiving concomitant corticosteroids, and kidney, heart, or lung transplant recipients.1 675 676 680 (See Geriatric use under Cautions.)

Other factors that may independently increase risk of tendon rupture include strenuous physical activity, renal failure, and previous tendon disorders such as rheumatoid arthritis.675 676 680 Tendinitis and tendon rupture have been reported in patients receiving fluoroquinolones who did not have any of these risk factors.680

Fluoroquinolone-associated tendinitis and tendon rupture most frequently involve the Achilles tendon and may require surgical repair.675 676 680 Tendinitis and tendon rupture in the rotator cuff (shoulder), hand, biceps, thumb, and other tendon sites also reported.680

Tendon rupture can occur during or following fluoroquinolone therapy and has been reported up to several months after completion of therapy.680

Discontinue if pain, swelling, inflammation, or rupture of a tendon occurs.1 675 676 680 Advise patients to rest and refrain from exercise and contact a clinician at the first sign of tendinitis or tendon rupture (e.g., pain, swelling, or inflammation of a tendon; weakness or inability to use a joint).1 675 676 680 (See Advice to Patients.)

Myasthenia Gravis Patients

May exacerbate muscle weakness in myasthenia gravis patients;1 need for ventilatory support and death reported.1

Avoid use in patients with known history of myasthenia gravis.1

Musculoskeletal Effects

Fluoroquinolones, including ofloxacin, cause arthropathy and osteochondrosis in immature animals of various species.1 339 342 359 413 417 420 421 428 446 464 Relevance of these adverse effects in immature animals to use in humans unknown.337 428 464 678 679 Safety and efficacy of ofloxacin not established in children and adolescents <18 years of age (see Pediatric Use under Cautions)or in pregnant or lactating women (see Pregnancy and see Lactation under Cautions).1

CNS Effects

Seizures, toxic psychoses, and increased intracranial pressure and CNS stimulation, which may lead to tremor, restlessness/agitation, nervousness/anxiety, lightheadedness, confusion, hallucinations, paranoia, depression, nightmares, insomnia, and, rarely, suicidal thoughts or acts, have been reported with quinolones, including ofloxacin.1

Use with caution in patients with known or suspected CNS disorders (e.g., severe cerebral arteriosclerosis, epilepsy) or other risk factors that predispose to seizures or lower the seizure threshold (e.g., certain drugs, renal impairment).1

If CNS effects occur, discontinue ofloxacin and institute appropriate measures.1

Peripheral Neuropathy

Sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias, and weakness reported with fluoroquinolones, including ofloxacin.1 Symptoms may occur soon after initiation of the drug and may be irreversible.1

Immediately discontinue ofloxacin if symptoms of peripheral neuropathy (e.g., pain, burning, tingling, numbness, weakness) occur or if there are alterations in sensations (e.g., light touch, pain, temperature, position sense, vibratory sensation).1

Prolongation of QT Interval

Prolonged QT interval leading to ventricular arrhythmias, including torsades de pointes, reported with some fluoroquinolones, including ofloxacin.1

Avoid use in patients with prolonged QT interval or uncorrected electrolyte disorders (e.g., hypokalemia, hypomagnesemia).1 Also avoid use in those receiving class IA (e.g., quinidine, procainamide) or class III (e.g., amiodarone, sotalol) antiarrhythmic agents.1 Risk may be increased in geriatric patients.1 (See Geriatric Use under Cautions.)

Superinfection/Clostridium difficile-associated Diarrhea and Colitis (CDAD)

Possible emergence and overgrowth of nonsusceptible bacteria or fungi.1 Institute appropriate therapy if superinfection occurs.1

Treatment with anti-infectives alters normal colon flora and may permit overgrowth of Clostridium difficile.1 607 609 610 663 C. difficile infection (CDI) and C. difficile-associated diarrhea and colitis (CDAD; also known as antibiotic-associated diarrhea and colitis or pseudomembranous colitis) have been reported with nearly all anti-infectives, including ofloxacin, and may range in severity from mild diarrhea to fatal colitis.1 341 343 352 353 350 351 355 356 607 609 610 C. difficile produces toxins A and B which contribute to development of CDAD;1 607 hypertoxin-producing strains of C. difficile are associated with increased morbidity and mortality since they may be refractory to anti-infectives and colectomy may be required.1

Outbreaks of severe CDAD caused by fluoroquinolone-resistant C. difficile have been reported with increasing frequency over the last several years.659 660 661 662 664

Consider CDAD if diarrhea develops during or after anti-infective therapy and manage accordingly.1 607 609 610 Obtain careful medical history since CDAD may occur as late as 2 months or longer after anti-infective therapy is discontinued.1

If CDAD is suspected or confirmed, discontinue anti-infectives not directed against C. difficile whenever possible.1 607 609 610 Initiate appropriate supportive therapy (e.g., fluid and electrolyte management, protein supplementation), anti-infective therapy directed against C. difficile (e.g., metronidazole, vancomycin), and surgical evaluation as clinically indicated.1 607 609 610

Sensitivity Reactions

Hypersensitivity Reactions

Serious and occasionally fatal hypersensitivity and/or anaphylactic reactions reported in patients receiving fluoroquinolones.1 These reactions may occur with first dose.1

Some hypersensitivity reactions have been accompanied by cardiovascular collapse, hypotension or shock, seizures, loss of consciousness, tingling, angioedema (e.g., edema or swelling of the tongue, larynx, throat, or face), airway obstruction (e.g., bronchospasm, shortness of breath, acute respiratory distress), urticaria, pruritus, and other severe skin reactions.1

In addition, other possible severe and potentially fatal reactions (may be hypersensitivity reactions or of unknown etiology) have been reported most frequently after multiple doses.1 These include fever, rash or other severe dermatologic reactions (e.g., toxic epidermal necrolysis, Stevens-Johnson syndrome), vasculitis, arthralgia, myalgia, serum sickness, allergic pneumonitis, interstitial nephritis, acute renal insufficiency or failure, hepatitis, jaundice, acute hepatic necrosis or failure, anemia (including hemolytic and aplastic), thrombocytopenia (including thrombotic thrombocytopenic purpura), leukopenia, agranulocytosis, pancytopenia and/or other hematologic effects.1

Discontinue ofloxacin at first appearance of rash, jaundice, or any other sign of hypersensitivity.1 Institute appropriate therapy as indicated (e.g., epinephrine, corticosteroids, maintenance of an adequate airway and oxygen).1

Photosensitivity Reactions

Moderate to severe photosensitivity reactions reported with fluoroquinolones, including ofloxacin.1

Avoid unnecessary exposure to sunlight or artificial UV light (sunlamps, solariums).1

Discontinue ofloxacin if photosensitivity (e.g., skin eruption) occurs.1

General Precautions

Selection and Use of Anti-infectives

When prescribing a fluoroquinolone, consider potential benefits and risks for the individual patient.675 676 Most patients tolerate the drugs, but serious adverse reactions (e.g., CNS effects, QT prolongation, C. difficile-associated diarrhea and colitis, damage to liver, kidneys, or bone marrow, alterations in glucose homeostasis) may occur rarely.675 676

To reduce development of drug-resistant bacteria and maintain effectiveness of ofloxacin and other antibacterials, use only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.1

When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing.1 In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.1

Resistance in Neisseria gonorrhoeae

N. gonorrhoeae with decreased susceptibility to fluoroquinolones (quinolone-resistant N. gonorrhoeae; QRNG) has been reported with increasing frequency over the past several years.319 642 671

US data indicate that QRNG has continued to increase among men who have sex with men and among heterosexual males and is now present in all regions of the country.671

CDC and others state that fluoroquinolones, including ofloxacin, should not be used to treat gonorrhea or any associated infections that may involve N. gonorrhoeae (e.g., PID, epididymitis).319 328 671 673

Laboratory Monitoring

Periodically assess organ system functions, including renal, hepatic, and hematopoietic, during therapy.1

Specific Populations

Pregnancy

Category C.1

Lactation

Distributed into milk;1 discontinue nursing or the drug.1

Pediatric Use

Safety and efficacy not established in children and adolescents <18 years of age.1 Causes arthropathy in juvenile animals.1 339 342 359 420 421 428 446 (See Musculoskeletal Effects under Cautions.)

AAP states use of fluoroquinolones may be justified in children <18 years of age in special circumstances after careful assessment of the risks and benefits for the individual patient and after these benefits and risks have been explained to the parents and/or caregivers.110 292

Geriatric Use

No substantial differences in safety and efficacy relative to younger adults.1

Risk of severe tendon disorders, including tendon rupture, is increased in geriatric adults >60 years of age.1 675 676 680 This risk is further increased in those receiving concomitant corticosteroids.1 675 676 680 (See Tendinopathy and Tendon Rupture under Cautions.) Use caution in geriatric adults, especially those receiving concomitant corticosteroids.680

Risk of QT interval prolongation leading to ventricular arrhythmias may be increased in geriatric patients, especially those receiving concurrent therapy with other drugs that can prolong QT interval (e.g., class IA or III antiarrhythmic agents) or with risk factors for torsades de pointes (e.g., known QT prolongation, uncorrected hypokalemia).1 (See Prolongation of QT Interval under Cautions.)

Consider age-related decreases in renal function when selecting dosage and adjust dosage if necessary.1 (See Renal Impairment under Dosage and Administration.)

Hepatic Impairment

Use with caution; perform appropriate hepatic function tests prior to and during therapy.1

Renal Impairment

Decreased clearance and increased half-life.1

Use with caution; perform appropriate renal function tests prior to and during therapy.1

Decrease dosage in those with Clcr ≤50 mL/minute.1 182 220 223 (See Renal Impairment under Dosage and Administration.)

Common Adverse Effects

GI effects (nausea, diarrhea, vomiting); nervous system effects (headache, dizziness, insomnia); rash; genital pruritus.1

Interactions for Ofloxacin

Drugs That Prolong QT Interval

Potential pharmacologic interaction (additive effect on QT interval prolongation).1 Avoid use in patients receiving class IA (e.g., quinidine, procainamide) or class III (e.g., amiodarone, sotalol) antiarrhythmic agents.1 (See Prolongation of QT Interval under Cautions.)

Specific Drugs and Laboratory Tests

Drug or Test

Interaction

Comments

Aminoglycosides

In vitro evidence of additive or synergistic antibacterial effects against Enterobacteriaceae and Ps. aeruginosa;371 373 375 synergism unpredictable and indifference or antagonism also reported 375

Antacids (aluminum-, magnesium-, or calcium-containing)

Decreased absorption of ofloxacin1 189 367 404 405 414 420 427 464

Administer ofloxacin at least 2 hours before or after such antacids1 404 414 427 536

Anticoagulants, oral (warfarin)

Potential for enhanced warfarin effects1 367 403 427 593

Use with caution; monitor PT1 367 403 427 593

Antidiabetic agents (glyburide, glibenclamide, insulin)

Blood glucose alterations (including hypoglycemia) reported in diabetic patients1

Closely monitor blood glucose concentrations1

β-lactam antibiotics

In vitro evidence of additive or synergistic antibacterial effects against some gram-positive bacteria;372 indifference against Enterobacteriaceae or Ps aeruginosa12

Caffeine

No evidence of clinically important effects on pharmacokinetics of caffeine;1 189 365 366 398 399 400 401 402 427 454 some other fluoroquinolones (e.g., ciprofloxacin) may affect caffeine pharmacokinetics189 365 366 398 399 400 401 402 427 454

Restrictions on caffeine intake not considered necessary398

Corticosteroids

Increased risk of tendinitis or tendon rupture, especially in patients >60 years of age1 675 676

Cyclosporine

Increased cyclosporine concentrations reported with some fluoroquinolones;1 unclear whether this occurs with ofloxacin1

Didanosine

Decreased absorption of ofloxacin with buffered didanosine preparations1

Administer ofloxacin at least 2 hours before or after buffered didanosine (pediatric oral solution admixed with antacid) 1

Histamine H2-receptor antagonists (cimetidine, ranitidine)

No evidence of pharmacokinetic interaction420 427 464

Iron preparations

Decreased absorption of ofloxacin1

Administer ofloxacin at least 2 hours before or after ferrous sulfate and dietary supplements containing iron1

Multivitamins and mineral supplements

Decreased absorption of ofloxacin1

Administer ofloxacin at least 2 hours before or after supplements containing zinc or iron1

NSAIAs

Possible increased risk of CNS stimulation, seizures;1 366 415 427 animal studies using other fluoroquinolones suggest risk may vary depending on the specific NSAIA670

Probenecid

Decreased clearance of some quinolones (e.g., ciprofloxacin);1 data regarding ofloxacin not available1

Sucralfate

Possible decreased GI absorption of ofloxacin1 592

Administer ofloxacin at least 2 hours before or after sucralfate1 592

Tests for opiates

Possible false-positive results with immunoassay kits for urine screening1

Confirmation of positive opiate test results using more specific methods may be necessary1

Theophylline

Possible increased theophylline concentrations and increased risk of theophylline-related adverse effects with fluoroquinolones1 181 189 191 365 366 367 368 378 379 380 382 383 384 385 386 387 389 391 392 393 394 395 396 397 416 427 464

Extent of this interaction varies considerably among the fluoroquinolones; the effect is less pronounced with norfloxacin or ofloxacin than with ciprofloxacin191 367 368 378 379 384 386 387 389 392 393 394 396 397 427

If used concomitantly, closely monitor patient and theophylline concentrations and make appropriate theophylline dosage adjustments as needed1

Ofloxacin Pharmacokinetics

Absorption

Bioavailability

Rapidly and almost completely absorbed from GI tract.1 171 172 175 183 188 194 464 Does not undergo appreciable first-pass metabolism.175

Oral bioavailability is 85–100%;1 169 175 188 189 210 peak serum concentrations attained within 0.5–2 hours.1 169 171 175 176 178 185 194 420 464

Food

Food can decrease rate and/or extent of absorption of ofloxacin;1 172 176 189 420 464 649 650 651 not usually considered clinically important.1 172 189 464 649 Milk and yogurt do not appear to affect GI absorption.649 650

Distribution

Extent

Widely distributed into body tissues and fluids,1 181 183 189 including bone,183 214 432 cartilage,432 bile,183 197 217 skin,1 sputum,1 183 189 195 214 430 bronchial secretions,189 196 206 214 230 pleural effusions,534 tonsils,203 saliva,185 186 192 gingival mucosa,186 nasal secretions,183 aqueous humor,214 215 tears,183 sweat,183 lung,1 183 189 205 219 228 430 blister fluid,1 183 189 192 226 pancreatic fluid,201 217 ascitic fluid,212 peritoneal fluid,225 458 gynecologic tissue,183 189 vaginal fluid,200 cervix,1 ovary,1 semen,453 prostatic fluid,1 181 183 198 202 214 and prostatic tissue.1 181 183 198 202 214

Distributed into CSF following oral administration;189 199 203 208 214 475 476 peak CSF concentrations may be 28–87% of concurrent serum concentrations.189 207 214 303 464 475 476

Crosses placenta and is distributed into cord blood and amniotic fluid.209 420 Distributed into milk.209 213 420

Plasma Protein Binding

20–32% bound to serum proteins;1 169 175 210 211 420 principally albumin.211

Elimination

Metabolism

<10% of a dose is metabolized;182 188 191 approximately 3–6% of the dose metabolized to desmethyl ofloxacin and 1–5% metabolized to ofloxacin N-oxide.169 175 182 190 191 Desmethyl ofloxacin is microbiologically active, but is less active against susceptible organisms than is ofloxacin; ofloxacin N-oxide has only minimal antibacterial activity.221

Elimination Route

Ofloxacin and its metabolites eliminated in both urine and feces.1 175 185 Following a single oral dose, 65–90% of the dose eliminated unchanged in urine within 48 hours;1 169 171 175 178 210 <5% of the dose in urine as metabolites.1 175 210 Approximately 4–8% of the dose excreted in feces.1 169

Half-life

Distribution half-life averages 0.5–0.6 hours and terminal elimination half-life averages 4–8 hours.169 171 175 176 178 185 194 420 464 535

Special Populations

In healthy geriatric adults 64–86 years of age with renal function normal for their age, half-life averages 6.4–8.5 hours.1 187 The slower elimination in geriatric individuals presumably is due to reduced renal function and clearance in this age group.1

Pharmacokinetics not fully evaluated in those with hepatic impairment.464

Serum concentrations are higher and half-life prolonged in adults with impaired renal function.1 174 181 182 189 220 221 222 223 224 225 226 227 420 431 458 464 Half-life averages 16.4 hours (range: 11–33.5 hours) in adults with Clcr 10–50 mL/minute and 21.7 hours (range: 16.9–28.4 hours) in those with Clcr <10 mL/minute.190 In patients with end-stage renal failure, half-life may range from 25–48 hours.227

Stability

Storage

Oral

Tablets

20–25°C; well-closed containers.1 Protect from light.1

Actions and Spectrum

  • Usually bactericidal.1 3 14 147 148 152 420 466

  • Like other fluoroquinolones, ofloxacin inhibits bacterial DNA gyrase and topoisomerase IV.1 632 633 634 635 636

  • Spectrum of activity includes many gram-positive aerobic bacteria, many gram-negative aerobic bacteria, and some other organisms (e.g., Chlamydia, Mycoplasma, Mycobacterium, Rickettsia).1 3 9 12 76 78 80 100 103 104 105 107 108 109 413 414 417 418 420 464 Inactive against fungi and viruses.413 464

  • In vitro activity against susceptible gram-positive bacteria approximately equal to that of ciprofloxacin;6 9 10 12 32 189 414 417 419 420 421 464 in vitro activity against susceptible gram-negative bacteria slightly less than that of ciprofloxacin.9 12 15 23 32 35 118 189 414 417 420 421 469 Generally less active against gram-positive than gram-negative bacteria.3 9 12 413 414 417 418 421

  • Gram-positive aerobic cocci: Active in vitro and in clinical infections against S. aureus (oxacillin-susceptible [methicillin-susceptible] strains only),1 S. epidermidis (oxacillin-susceptible strains only),1 S. pneumoniae (penicillin-susceptible strains),1 S. pyogenes (group A β-hemolytic streptococci),1 S. saprophyticus, and Enterococcus faecalis.3 6 12 13 14 15 16 17 19 21 22 23 25 26 27 28 31 32 34 74 114 504 Also active in vitro against some other staphylococci (e.g., S. haemolyticus, S. hominis), some penicillin-resistant S. pneumoniae, viridans streptococci, groups C, F, and G streptococci, and nonenterococcal group D streptococci.1 14 21 22 23 29 35

  • Gram-positive aerobic bacilli: Active against Bacillus anthracis,621 622 630 631 Corynebacterium,21 25 26 32 62 66 and Listeria monocytogenes.21 22 25 26 27 32 34 37 420 Nocardia asteroides usually are resistant.32 35 63 420 504

  • Gram-negative aerobes: Active in vitro and in clinical infections against Campylobacter jejuni, H. influenzae, H. parainfluenzae, M. catarrhalis, Ps. aeruginosa, and most Enterobacteriaceae (including Citrobacter, Edwardsiella, Enterobacter, E. coli, Klebsiella, M. morganii, P. mirabilis, P. vulgaris, Providencia, Salmonella, Shigella, Serratia, Yersinia enterocolitica).1 3 6 12 13 14 15 16 17 19 21 23 26 27 28 31 32 34 52 420 467 504 Also active in vitro against Acinetobacter, Aeromonas, Brucella, Francisella tularensis, Legionella pneumophila, Vibrio, and Yersinia pestis.3 13 21 22 25 27 32 34 37 75 79 92 97 420 469 623 624 625 627 Burkholderia cepacia are resistant.12 21 25 27 34 37 50 58 75

  • Other organisms: Active in vitro and in clinical infections against by C. pneumoniae,1 32 34 45 82 83 84 85 86 88 90 569 M. pneumoniae,87 91 420 464 568 M. tuberculosis,93 94 96 98 99 100 105 108 M. fortuitum,256 332 333 674 and other mycobacteria.98 99 104

  • N. gonorrhoeae with decreased susceptibility to ofloxacin and other fluoroquinolones (quinolone-resistant N. gonorrhoeae; QRNG) are widely disseminated worldwide, including in the US.319 578 580 581 583 584 585 642 671

  • Some cross-resistance occurs between ofloxacin and other fluoroquinolones.118 414 418 420 421 441

Advice to Patients

  • Advise patients that antibacterials (including ofloxacin) should only be used to treat bacterial infections and not used to treat viral infections (e.g., the common cold).1

  • Importance of completing full course of therapy, even if feeling better after a few days.1

  • Advise patients that skipping doses or not completing the full course of therapy may decrease effectiveness and increase the likelihood that bacteria will develop resistance and will not be treatable with ofloxacin or other antibacterials in the future.1

  • Importance of taking ofloxacin at least 2 hours before or after multivitamins containing calcium, magnesium, or zinc; aluminum- or magnesium-containing antacids; or buffered didanosine (pediatric oral solution admixed with antacid).1

  • May be taken without regard to meals.1

  • Importance of drinking sufficient quantities of fluids during therapy.1

  • Importance of discontinuing ofloxacin and informing clinician if rash, hives, or other manifestation suggesting allergic reaction (e.g., rapid heart beat, difficulty swallowing or breathing, swelling of lips, tongue, face, tightness in throat or hoarseness) occurs.1

  • Increased risk of tendinitis and tendon rupture in all age groups and further increased risk in adults >60 years of age, individuals receiving corticosteroids, and kidney, heart, or lung transplant recipients.1 675 676 680 Importance of resting and refraining from exercise at the first sign of tendinitis or tendon rupture (e.g., pain, swelling, or inflammation of a tendon; weakness or inability to use a joint), discontinuing the drug, and contacting a clinician regarding changing to an anti-infective that is not a fluoroquinolone.1 675 676 680 (See Tendinopathy and Tendon Rupture under Cautions.)

  • Advise patients that ofloxacin may worsen myasthenia gravis symptoms; importance of immediately contacting clinician if any worsening muscle weakness or breathing problems occur.1

  • Potential for ofloxacin to cause dizziness and lightheadedness; need for caution when operating machinery or driving a motor vehicle until effects of drug on individual are known.1

  • Advise patients to avoid excessive sunlight or artificial UV light during therapy and to discontinue ofloxacin if phototoxicity occurs.1

  • Advise patients that seizures have been reported and to contact clinicians before taking ofloxacin if they have a history of seizures.1

  • Advise patients that peripheral neuropathies have been reported with ofloxacin and that symptoms may occur soon after initiation of the drug and may be irreversible.1 Importance of immediately discontinuing the drug and contacting clinician if symptoms of peripheral neuropathy (e.g., pain, burning, tingling, numbness, weakness) occur.1

  • Importance of discontinuing ofloxacin and consulting clinician if symptoms of peripheral neuropathy (e.g., pain, burning, tingling, numbness, weakness) develop.1

  • Advise patients that diarrhea is a common problem caused by anti-infectives and usually ends when the drug is discontinued.1 Importance of contacting a clinician if watery and bloody stools (with or without stomach cramps and fever) occur during or as late as 2 months or longer after the last dose.1

  • Advise diabetic patients that hypoglycemic reactions have been reported and to discontinue ofloxacin and contact a clinician if a hypoglycemic reaction occurs.1

  • Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs.1

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1

  • Importance of advising patients of other important precautionary information.1 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Ofloxacin

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets, film-coated

200 mg*

Ofloxacin Tablets

300 mg*

Ofloxacin Tablets

400 mg*

Ofloxacin Tablets

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 11/2013. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Ofloxacin 200MG Tablets (RANBAXY PHARMACEUTICALS): 14/$66.99 or 42/$179.97

Ofloxacin 300MG Tablets (TEVA PHARMACEUTICALS USA): 14/$65.99 or 42/$185.95

AHFS DI Essentials. © Copyright, 2004-2013, Selected Revisions October 12, 2013. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

1. Teva Pharmaceuticals USA Inc. Ofloxacin tablets prescribing information. Sellersville, PA; 2013 Jul.

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