ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -2 مورد

Ofloxacin (systemic): Drug information

Ofloxacin (systemic): Drug information
2025© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Ofloxacin (systemic): Patient drug information" and "Ofloxacin (systemic): Pediatric drug information"

For abbreviations, symbols, and age group definitions show table
ALERT: US Boxed Warning
Serious adverse reactions:

Fluoroquinolones have been associated with disabling and potentially irreversible serious adverse reactions that have occurred together, including tendinitis and tendon rupture, peripheral neuropathy, and CNS effects. Discontinue ofloxacin immediately and avoid the use of fluoroquinolones in patients who experience any of these serious adverse reactions. Because fluoroquinolones have been associated with serious adverse reactions, reserve ofloxacin for use in patients who have no alternative treatment options for the following indications: acute exacerbation of chronic bronchitis and acute uncomplicated cystitis.

Myasthenia gravis:

Fluoroquinolones may exacerbate muscle weakness in persons with myasthenia gravis. Avoid ofloxacin in patients with a known history of myasthenia gravis.

Pharmacologic Category
  • Antibiotic, Fluoroquinolone
Dosing: Adult
Epididymitis, acute

Epididymitis, acute (off-label use):

Likely caused by enteric organisms: Oral: 200 mg twice daily for 14 days (Ref).

Likely caused by sexually transmitted chlamydia and gonorrhea, and enteric organisms (patients who practice insertive anal sex): Oral: 200 mg twice daily for 10 days in combination with ceftriaxone (Ref).

Plague

Plague (Y. pestis), (alternative agent) (off-label use):

Note: Consult public health officials for event-specific recommendations.

Postexposure prophylaxis: Oral: 400 mg every 12 hours for 7 days (Ref).

Treatment, excluding meningitis: Oral: 400 mg every 12 hours for 7 to 14 days and for at least a few days after clinical resolution (Ref).

Pneumonia, community acquired

Pneumonia, community acquired: Oral: 400 mg every 12 hours (Ref). Duration is for a minimum of 5 days; patients should be clinically stable with normal vital signs prior to discontinuation (Ref).

Prostatitis

Prostatitis: Oral: 300 mg every 12 hours for 6 weeks.

Sexually transmitted infections

Sexually transmitted infections:

Cervicitis/urethritis due to Chlamydia trachomatis: Oral: 300 mg every 12 hours for 7 days.

Pelvic inflammatory disease, outpatient therapy, mild to moderate disease (alternative agent):

Note: Reserve fluoroquinolones for patients who cannot use first-line options and are at low risk for fluoroquinolone-resistant Neisseria gonorrhoeae (eg, prevalence is <5% in the location where the infection was acquired) (Ref).

Oral: 400 mg every 12 hours for 10 to 14 days. Guidelines recommend use of a fluoroquinolone in combination with metronidazole (Ref).

Skin and soft tissue infection, uncomplicated

Skin and soft tissue infection, uncomplicated: Oral: 400 mg every 12 hours (Ref). Treat for 5 to 14 days depending on severity and clinical response (Ref).

Typhoid and paratyphoid fever, uncomplicated, treatment

Typhoid and paratyphoid fever (S. typhi or S. paratyphi infection), uncomplicated, treatment (off-label use): Note: Use only if minimum inhibitory concentration ≤0.125 mcg/mL (Ref).

Oral: 400 mg twice daily for 7 days (Ref).

Urinary tract infection

Urinary tract infection:

Cystitis, acute uncomplicated or acute simple cystitis (infection limited to the bladder without signs/symptoms of upper tract, prostate, or systemic infection) (alternative agent):

Note: Use is discouraged due to safety concerns and increasing resistance; reserve for those who have no alternative treatment options (Ref). However, for men who have severe symptoms or there is concern for early prostate involvement, some experts prefer fluoroquinolones (Ref).

Oral: 200 mg every 12 hours for 3 days (females) or 5 days (males) (Ref).

Urinary tract infection, complicated (including pyelonephritis):

Note: If the prevalence of fluoroquinolone resistance is >10%, an initial dose of a long-acting parenteral antimicrobial (eg, ceftriaxone) followed by oral therapy is recommended for outpatients (Ref).

Oral: 200 mg every 12 hours for 5 to 7 days (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

Oral: After a normal initial dose, adjust as follows:

CrCl >50 mL/minute: No dosage adjustment necessary.

CrCl 20 to 50 mL/minute: Administer usual recommended dose every 24 hours.

CrCl <20 mL/minute: Administer half the usual recommended dose every 24 hours.

Intermittent hemodialysis (IHD): 100 to 200 mg after dialysis (Ref).

Peritoneal dialysis: 200 mg every 24 hours (Ref).

Continuous renal replacement therapy (CRRT): 300 mg every 24 hours (Ref).

Dosing: Liver Impairment: Adult

Mild to moderate impairment: There are no dosage adjustments provided in the manufacturer’s labeling; use with caution.

Severe impairment (eg, cirrhosis with or without ascites): Maximum dose: 400 mg/day

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Ofloxacin (systemic): Pediatric drug information")

General dosing, susceptible infection: Limited data available: Children: Oral: 15 mg/kg/day divided every 12 hours (Ref); usual adult dose: 200 to 400 mg every 12 hours (Ref).

Chlamydia trachomatis anogenital tract infection

Chlamydia trachomatis anogenital tract infection: Limited data available: Children weighing ≥45 kg and Adolescents: Oral: 300 mg twice daily for 7 days (Ref).

Epididymitis

Epididymitis: Likely caused by enteric organisms (eg, Escherichia coli) in males who practice insertive anal sex: Children weighing ≥45 kg and Adolescents: Limited data available: Oral: 300 mg every 12 hours for 10 days in combination with ceftriaxone (Ref).

Pelvic inflammatory disease

Pelvic inflammatory disease (alternative therapy): Children weighing ≥45 kg and Adolescents: Limited data available: Oral: 400 mg every 12 hours for 10 to 14 days in combination with metronidazole (Ref). Note: The CDC recommends use only if standard cephalosporin therapy is not feasible (patients with severe cephalosporin allergy) and community prevalence of quinolone-resistant gonococcal organisms is low. Culture and susceptibility must be confirmed, and patient follow-up should be ensured (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no pediatric-specific recommendations; based on experience in adult patients, dosage adjustment is suggested.

Dosing: Liver Impairment: Pediatric

There are no pediatric-specific recommendations. Based on experience in adult patients, dosage adjustment is suggested in patients with severe impairment.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Reactions listed may be based on reports for other agents in this same pharmacologic class (quinolones) and may not be specifically reported for ofloxacin.

1% to 10%:

Cardiovascular: Chest pain (1% to 3%)

Dermatologic: Pruritus (1% to 3%), skin rash (1% to 3%)

Gastrointestinal: Abdominal cramps (1% to 3%), abdominal pain (1% to 3%), constipation (1% to 3%), decreased appetite (1% to 3%), diarrhea (1% to 4%), dysgeusia (1% to 3%), flatulence (1% to 3%), gastrointestinal distress (1% to 3%), nausea (3% to 10%), vomiting (1% to 4%), xerostomia (1% to 3%)

Genitourinary: Genital pruritus (female: 1% to 6%), vaginal discharge (1% to 3%), vaginitis (1% to 5%)

Nervous system: Dizziness (1% to 5%), drowsiness (1% to 3%), fatigue (1% to 3%), headache (1% to 9%), insomnia (3% to 7%), nervousness (1% to 3%), sleep disorder (1% to 3%), torso pain (1% to 3%)

Ophthalmic: Visual disturbance (1% to 3%)

Respiratory: Pharyngitis (1% to 3%)

Miscellaneous: Fever (1% to 3%)

<1%:

Cardiovascular: Hypertension, hypotension, palpitations, syncope, vasodilation

Dermatologic: Diaphoresis, urticaria

Endocrine & metabolic: Heavy menstrual bleeding, increased thirst, weight loss

Genitourinary: Dysmenorrhea, dysuria, genital pain (female), genital rash (female), urinary frequency, urinary retention, uterine hemorrhage, vulvovaginal burning, vulvovaginal irritation

Hypersensitivity: Angioedema

Nervous system: Abnormal dreams, anxiety, asthenia, chills, cognitive dysfunction, confusion, depression, euphoria, malaise, pain, seizure, vertigo

Neuromuscular & skeletal: Arthralgia, myalgia

Ophthalmic: Photophobia

Otic: Auditory disturbance, tinnitus

Respiratory: Cough, epistaxis, rhinorrhea

Frequency not defined:

Cardiovascular: Cardiac arrhythmia, prolonged QT interval on ECG

Endocrine & metabolic: Hyperglycemia, hypoglycemia

Genitourinary: Glycosuria, hematuria, proteinuria, pyuria

Hematologic & oncologic: Anemia, eosinophilia, increased erythrocyte sedimentation rate, leukocytosis, leukopenia, lymphocytopenia, lymphocytosis, neutropenia, neutrophilia, thrombocytopenia, thrombocythemia

Hepatic: Increased serum alanine aminotransferase, increased serum alkaline phosphatase, increased serum aspartate aminotransferase

Nervous system: Exacerbation of myasthenia gravis, increased intracranial pressure, peripheral neuropathy (including axonal peripheral polyneuropathy, dysesthesia, hypoesthesia, sensorimotor neuropathy, and sensory peripheral polyneuropathy), psychiatric signs and symptoms (including agitation, delirium, disorientation, disturbance in attention, memory impairment, restlessness, and toxic psychosis)

Neuromuscular & skeletal: Rupture of tendon, tendinopathy

Renal: Decreased urine specific gravity, increased blood urea nitrogen, increased serum creatinine, increased urine pH

Postmarketing:

Cardiovascular: Edema (Guay 1992), torsades de pointes, vasculitis (Pace 1989)

Dermatologic: Erythema multiforme (Nettis 2002), maculopapular rash (Guay 1992), Stevens-Johnson syndrome, toxic epidermal necrolysis (Yoon 2010)

Endocrine & metabolic: Diabetes insipidus (Bharani 2001)

Gastrointestinal: Clostridioides difficile-associated diarrhea, dyspepsia (Wilton 1996)

Hematologic & oncologic: Agranulocytosis, aplastic anemia, hemolytic anemia, pancytopenia, thrombotic thrombocytopenic purpura

Hepatic: Hepatic necrosis, hepatitis (Jones 1997), hepatotoxicity (idiosyncratic) (Chalasani 2014), jaundice

Hypersensitivity: Anaphylaxis, hypersensitivity angiitis (Ceyhan 1995), hypersensitivity reaction (Wilton 1996), serum sickness

Nervous system: Hallucination (Wilton 1996), paresthesia (Guay 1992), tremor (Wilton 1996)

Neuromuscular & skeletal: Limb pain (Guay 1992)

Renal: Acute kidney injury, interstitial nephritis, renal insufficiency

Respiratory: Hypersensitivity pneumonitis

Contraindications

Hypersensitivity to ofloxacin, other quinolones, or any component of the formulation

Warnings/Precautions

Concerns related to adverse effects:

• Altered cardiac conduction: Fluoroquinolones may prolong QTc interval; avoid use in patients with a history of QTc prolongation, uncorrected hypokalemia, hypomagnesemia, or concurrent administration of other medications known to prolong the QT interval (including Class Ia and Class III antiarrhythmics, cisapride, erythromycin, antipsychotics, and tricyclic antidepressants).

• Aortic aneurysm and dissection: Fluoroquinolones have been associated with aortic aneurysm ruptures or dissection within 2 months following use, particularly in elderly patients. Fluoroquinolones should not be used in patients with a known history of aortic aneurysm or those at increased risk, including patients with peripheral atherosclerotic vascular diseases, hypertension, genetic disorders involving blood vessel changes (eg, Marfan syndrome, Ehlers-Danlos syndrome), and elderly patients, unless no other treatment options are available. Longer treatment duration (eg, >14 days) may increase risk (Lee 2018).

• CNS effects: Fluoroquinolones have been associated with an increased risk of CNS effects including seizures, increased intracranial pressure (including pseudotumor cerebri), dizziness, lightheadedness, and tremors. Use with caution in patients with known or suspected CNS disorders (eg, severe cerebral arteriosclerosis, epilepsy) or other risk factors that may predispose to seizures or lower the seizure threshold.

• Glucose regulation: Fluoroquinolones have been associated with disturbances in glucose regulation, including hyperglycemia and hypoglycemia. These events have occurred most often in patients receiving concomitant oral hypoglycemic agents or insulin. Severe cases of hypoglycemia, including coma and death, have been reported. Diabetic patients should be monitored closely for signs/symptoms of disordered glucose regulation. Discontinue if a hypoglycemic reaction occurs and immediately initiate appropriate therapy.

• Hypersensitivity reactions: Severe, sometimes fatal, hypersensitivity reactions, including anaphylaxis, have occurred with quinolone therapy. The spectrum of these reactions can vary widely; reactions may present as typical allergic symptoms (eg, itching, urticaria, rash, edema) after a single dose, or may manifest as severe idiosyncratic dermatologic (eg, Stevens-Johnson, toxic epidermal necrolysis), vascular (eg, vasculitis), pulmonary (eg, pneumonitis), renal (eg, nephritis), hepatic (eg, hepatic failure or necrosis), and/or hematologic (eg, anemia, cytopenias) events, usually after multiple doses. Prompt discontinuation of drug should occur if skin rash or other symptoms arise.

• Peripheral neuropathy: Peripheral neuropathy has been reported (rare); may occur soon after initiation of therapy and may be irreversible; discontinue if symptoms of sensory or sensorimotor neuropathy occur.

• Phototoxicity: Avoid excessive sunlight and take precautions to limit exposure (eg, loose fitting clothing, sunscreen); may cause moderate to severe phototoxicity reactions. Discontinue use if photosensitivity occurs.

• Psychiatric reactions: Fluoroquinolones have been associated with an increased risk of psychiatric reactions, including toxic psychosis or hallucinations; may also cause nervousness, agitation, confusion, disorientation, delirium, attention disturbances, and memory impairment. Use with caution in patients with a history of or risk factor for depression; discontinue if reaction occurs and institute appropriate therapy.

• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.

Disease-related concerns:

• Hepatic impairment: Use with caution in patients with hepatic impairment.

• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment required. May increase risk of tendon rupture.

• Rheumatoid arthritis: Use with caution in patients with rheumatoid arthritis; may increase risk of tendon rupture.

• Seizures: Use with caution in individuals at risk of seizures (CNS disorders or concurrent therapy with medications which may lower seizure threshold). Potential for seizures, although very rare, may be increased with concomitant NSAID therapy.

• Syphilis: Since ofloxacin is ineffective in the treatment of syphilis and may mask symptoms, all patients should be tested for syphilis at the time of gonorrheal diagnosis and 3 months later. Note: As of April 2007, the CDC no longer recommends the use of fluoroquinolones for the treatment of uncomplicated gonococcal disease.

Special populations:

• Older adult: Adverse effects (eg, tendon rupture, QT changes) may be increased in the elderly.

• G6PD deficiency: Hemolytic reactions may (rarely) occur with fluoroquinolone use in patients with G6PD deficiency (Luzzatto 2020).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Generic: 300 mg, 400 mg

Generic Equivalent Available: US

Yes

Pricing: US

Tablets (Ofloxacin Oral)

300 mg (per each): $14.76

400 mg (per each): $19.68

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Generic: 200 mg, 300 mg, 400 mg

Administration: Adult

Oral: Administer with or without food. Do not take within 2 hours of sucralfate, didanosine, iron, zinc, or antacids containing magnesium, calcium, or aluminum.

Enteral feeding tube:

The following recommendations are based upon the best available evidence and clinical expertise. Senior editorial team: Joseph I. Boullata, PharmD, RPh, CNS-S, FASPEN, FACN; Peggi A. Guenter, PhD, RN, FASPEN; Kathleen Gura, PharmD, BCNSP, FASHP, FASPEN, FPPA, FMSHP; Mark G. Klang, MS, RPh, BCNSP, PhD, FASPEN; Linda Lord, NP, ACNP-BC, CNSC, FASPEN.

Oral tablet:

Gastric (eg, NG, G-tube ) or post-pyloric (eg, J-tube) tubes (≥6 French): Consider separating ofloxacin tablet administration from enteral nutrition (EN) based on patient-specific factors and institutional policy. Crush tablet(s) into a fine powder and disperse in ≥10 mL purified water immediately prior to administration; draw up mixture into enteral dosing syringe. Administer immediately via feeding tube (Ref).

Dosage form information: Some formulations may be film-coated; administration of film-coated ofloxacin tablets via feeding tube may increase the risk of clogging the tube; if used, ensure tablets are dispersed sufficiently with an adequate amount of purified water prior to administration (Ref).

General guidance: May consider holding EN for 1 to 2 hours prior to and 2 hours following ofloxacin tablet administration for adequate absorption, based on patient-specific factors and institutional policy (Ref). Flush feeding tube with an appropriate volume of purified water (eg, 15 mL) before administration (Ref). Following administration, rinse container or syringe used for preparation with purified water; draw up rinse and administer contents to ensure delivery of entire dose (Ref). Flush feeding tube with an appropriate volume of purified water (eg, 15 mL) and restart EN (Ref); consider restarting EN 2 hours after ofloxacin administration to ensure adequate absorption (Ref). The interruption of enteral feeding to allow for ofloxacin administration may impact patient nutrition; adjustment of feeding rates may be necessary to meet patient’s nutritional needs (Ref).

Enteral nutrition considerations: Manufacturer’s labeling suggests ofloxacin tablets can be administered without regard to meals. Reduced serum concentrations have been reported with crushed ofloxacin tablets when mixed with EN; however, the pharmacokinetic changes were not considered to be clinically significant (Ref). Studies evaluating fluoroquinolone absorption when administered with EN have mixed results; while studies in healthy volunteers suggest separation of EN and fluoroquinolones is not necessary, other studies suggest absorption can be variable, particularly in certain patient populations (eg, critically ill). Patient-specific parameters (eg, illness severity, post abdominal surgery, composition of feeds) and institutional policies should be considered when determining how to time administration (Ref).

Note: Recommendations may not account for differences in inactive ingredients, osmolality, or other formulation properties that may vary among products from different manufacturers.

Administration: Pediatric

The following recommendations are based upon the best available evidence and clinical expertise. Senior editorial team: Joseph I. Boullata, PharmD, RPh, CNS-S, FASPEN, FACN; Peggi A. Guenter, PhD, RN, FASPEN; Kathleen Gura, PharmD, BCNSP, FASHP, FASPEN, FPPA, FMSHP; Mark G. Klang, MS, RPh, BCNSP, PhD, FASPEN; Linda Lord, NP, ACNP-BC, CNSC, FASPEN.

Note: Recommendations may not account for differences in inactive ingredients, osmolality, or other formulation properties that may vary among products from different manufacturers.

Oral:

Tablet: May administer with or without food.

Administration via feeding tube:

Gastric (eg, NG, G-tube) or post-pyloric (eg, J-tube) tubes (≥6 French): Consider separating ofloxacin tablet administration from enteral nutrition based on patient-specific factors and institutional policy. Crush tablet(s) into a fine powder and disperse in ≥10 mL purified water immediately prior to administration; draw up mixture into enteral dosing syringe. Administer immediately via feeding tube (Ref).

Dosage form information: Some tablets may be film-coated; administration of film-coated ofloxacin tablets via feeding tube may increase the risk of clogging the tube; if used, ensure tablets are sufficiently dispersed prior to administration (Ref).

General guidance: May consider holding enteral nutrition for 1 to 2 hours prior to and 2 hours following ofloxacin tablet administration for adequate absorption, based on patient-specific factors and institutional policy (Ref). Flush feeding tube with the lowest volume of purified water necessary to clear the tube prior to administration based on size of patient and/or feeding tube (eg, neonates: 1 to 3 mL; infants and children: 2 to 5 mL; adolescents: 15 mL); refer to institutional policies and procedures (Ref). Following administration, rinse container used for preparation with purified water; draw up rinse and administer contents to ensure delivery of entire dose (Ref). Flush feeding tube with an appropriate volume of purified water and restart enteral nutrition (Ref); consider restarting enteral nutrition 2 hours after ofloxacin administration to ensure adequate absorption (Ref). The interruption of enteral feeding to allow for ofloxacin administration may impact patient nutrition; adjustment of feeding rates may be necessary to meet patient’s nutritional needs (Ref).

Note: Enteral nutrition considerations: Manufacturer’s labeling suggests ofloxacin tablets can be administered without regard to meals. Reduced serum concentrations have been reported with crushed ofloxacin tablets when mixed with enteral nutrition; however, the pharmacokinetic changes were not considered to be clinically significant (Ref). Studies evaluating fluoroquinolone absorption when administered with enteral nutrition have mixed results; while studies in healthy volunteers suggest separation of enteral nutrition and fluoroquinolones is not necessary, other studies suggest absorption can be variable, particularly in certain patient populations (eg, critically ill). Patient-specific parameters (eg, illness severity, post abdominal surgery, composition of feeds) and institutional policies should be considered when determining how to time administration (Ref).

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and at http://www.fda.gov/downloads/Drugs/DrugSafety/ucm088599.pdf, must be dispensed with this medication.

Use: Labeled Indications

Treatment of community-acquired pneumonia, acute bacterial exacerbations of chronic bronchitis, skin and soft tissue infections (uncomplicated), urethritis and cervicitis (nongonococcal) due to Chlamydia trachomatis infection, pelvic inflammatory disease (acute), cystitis (uncomplicated), urinary tract infections (complicated), prostatitis.

Limitations of use: Because fluoroquinolones, including ofloxacin, have been associated with disabling and potentially irreversible serious adverse reactions (eg, tendinopathy and tendon rupture, peripheral neuropathy, CNS effects), reserve ofloxacin for use in patients who have no alternative treatment options for uncomplicated urinary tract infection and for acute exacerbations of chronic bronchitis when treatment is necessary (FDA 2016).

Use: Off-Label: Adult

Epididymitis, acute; Plague (Yersinia pestis); Typhoid and paratyphoid fever (Salmonella typhi or S. parathyphi infection), uncomplicated, treatment

Metabolism/Transport Effects

Substrate of OAT1/3;

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Agents with Blood Glucose Lowering Effects: Quinolones may increase hypoglycemic effects of Agents with Blood Glucose Lowering Effects. Quinolones may decrease therapeutic effects of Agents with Blood Glucose Lowering Effects. Specifically, if an agent is being used to treat diabetes, loss of blood sugar control may occur with quinolone use. Risk C: Monitor

Aminolevulinic Acid (Systemic): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Systemic). Risk X: Avoid

Aminolevulinic Acid (Topical): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Topical). Risk C: Monitor

Amphetamines: May increase cardiotoxic effects of Quinolones. Risk C: Monitor

Antacids: May decrease absorption of Quinolones. Of concern only with oral administration of quinolones. Management: Avoid concurrent administration of quinolones and antacids to minimize the impact of this interaction. Recommendations for optimal dose separation vary by specific quinolone; see full monograph for details. Risk D: Consider Therapy Modification

Bacillus clausii: Antibiotics may decrease therapeutic effects of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider Therapy Modification

BCG (Intravesical): Antibiotics may decrease therapeutic effects of BCG (Intravesical). Risk X: Avoid

BCG Vaccine (Immunization): Antibiotics may decrease therapeutic effects of BCG Vaccine (Immunization). Risk C: Monitor

Calcium Salts: May decrease absorption of Quinolones. Of concern only with oral administration of both agents. Management: Consider administering an oral quinolone at least 2 hours before or 6 hours after the dose of oral calcium to minimize this interaction. Monitor for decreased therapeutic effects of quinolones during coadministration. Risk D: Consider Therapy Modification

Cholera Vaccine: Antibiotics may decrease therapeutic effects of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid

Corticosteroids (Systemic): May increase adverse/toxic effects of Quinolones. Specifically, the risk of tendonitis and tendon rupture may be increased. Risk C: Monitor

Delamanid: Quinolones may increase QTc-prolonging effects of Delamanid. Management: Avoid concomitant use if possible. If coadministration is unavoidable, frequent monitoring of electrocardiograms (ECGs) throughout the full delamanid treatment period should occur. Risk D: Consider Therapy Modification

Didanosine: Quinolones may decrease serum concentration of Didanosine. Didanosine may decrease serum concentration of Quinolones. Management: Administer oral quinolones at least 2 hours before or 6 hours after didanosine. Monitor for decreased therapeutic effects of quinolones, particularly if doses cannot be separated as recommended. This does not apply to unbuffered enteric coated didanosine. Risk D: Consider Therapy Modification

Fecal Microbiota (Live) (Oral): May decrease therapeutic effects of Antibiotics. Risk X: Avoid

Fecal Microbiota (Live) (Rectal): Antibiotics may decrease therapeutic effects of Fecal Microbiota (Live) (Rectal). Risk X: Avoid

Haloperidol: QT-prolonging Agents (Indeterminate Risk - Avoid) may increase QTc-prolonging effects of Haloperidol. Risk C: Monitor

Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may decrease therapeutic effects of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor

Iron Preparations: May decrease serum concentration of Quinolones. Management: Give oral quinolones at least several hours before (4 h for moxi- and sparfloxacin, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome-, 3 h for gemi-, and 2 h for enox-, levo-, nor-, oflox-, peflox, or nalidixic acid) oral iron. Risk D: Consider Therapy Modification

Lactobacillus and Estriol: Antibiotics may decrease therapeutic effects of Lactobacillus and Estriol. Risk C: Monitor

Lanthanum: May decrease serum concentration of Quinolones. Management: Administer oral quinolone antibiotics at least one hour before or four hours after lanthanum. Risk D: Consider Therapy Modification

Levoketoconazole: QT-prolonging Agents (Indeterminate Risk - Avoid) may increase QTc-prolonging effects of Levoketoconazole. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

Magnesium Salts: May decrease serum concentration of Quinolones. Management: Administer oral quinolones several hours before (4 h for moxi/pe/spar/enox-, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome/pe/enox-, 3 h for gemi-, and 2 h for levo-, nor-, or ofloxacin or nalidixic acid) oral magnesium salts. Risk D: Consider Therapy Modification

Methoxsalen (Systemic): Photosensitizing Agents may increase photosensitizing effects of Methoxsalen (Systemic). Risk C: Monitor

Methylphenidate: May increase cardiotoxic effects of Quinolones. Risk C: Monitor

Multivitamins/Minerals (with ADEK, Folate, Iron): May decrease serum concentration of Quinolones. Specifically, polyvalent cations in multivitamin products may decrease the absorption of orally administered quinolone antibiotics. Management: Administer oral quinolones at least 2 hours before, or 6 hours after, the dose of a multivitamin that contains polyvalent cations (ie, calcium, iron, magnesium, selenium, zinc). Monitor for decreased quinolone efficacy. Risk D: Consider Therapy Modification

Multivitamins/Minerals (with AE, No Iron): May decrease serum concentration of Quinolones. Specifically, minerals in the multivitamin/mineral product may impair absorption of quinolone antibiotics. Management: Administer oral quinolones at least 2 hours before, or 6 hours after, the dose of a multivitamin that contains polyvalent cations (ie, calcium, iron, magnesium, selenium, zinc). Monitor for decreased therapeutic effects of quinolones. Risk D: Consider Therapy Modification

Mycophenolate: Antibiotics may decrease active metabolite exposure of Mycophenolate. Specifically, concentrations of mycophenolic acid (MPA) may be reduced. Risk C: Monitor

Nadifloxacin: May increase adverse/toxic effects of Quinolones. Risk X: Avoid

Nonsteroidal Anti-Inflammatory Agents: May increase neuroexcitatory and/or seizure-potentiating effects of Quinolones. Nonsteroidal Anti-Inflammatory Agents may increase serum concentration of Quinolones. Risk C: Monitor

Polyethylene Glycol-Electrolyte Solution: May decrease absorption of Quinolones. Management: Give oral quinolones at least 2 hours before or at least 6 hours after polyethylene glycol-electrolyte solutions that contain magnesium sulfate (Suflave brand). Other products without magnesium do not require dose separation. Risk D: Consider Therapy Modification

Porfimer: Photosensitizing Agents may increase photosensitizing effects of Porfimer. Risk X: Avoid

Probenecid: May increase serum concentration of Quinolones. Probenecid may decrease excretion of Quinolones. Specifically, probenecid may decreased the renal excretion of quinolone antibiotics. Risk C: Monitor

QT-prolonging Agents (Highest Risk): QT-prolonging Agents (Indeterminate Risk - Avoid) may increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

Sodium Picosulfate: Antibiotics may decrease therapeutic effects of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider Therapy Modification

Strontium Ranelate: May decrease serum concentration of Quinolones. Management: In order to minimize any potential impact of strontium ranelate on quinolone antibiotic concentrations, it is recommended that strontium ranelate treatment be interrupted during quinolone therapy. Risk X: Avoid

Sucralfate: May decrease serum concentration of Quinolones. Management: Avoid concurrent administration of quinolones and sucralfate to minimize the impact of this interaction. Recommendations for optimal dose separation vary by specific quinolone. Risk D: Consider Therapy Modification

Typhoid Vaccine: Antibiotics may decrease therapeutic effects of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider Therapy Modification

Verteporfin: Photosensitizing Agents may increase photosensitizing effects of Verteporfin. Risk C: Monitor

Vitamin K Antagonists: Quinolones may increase anticoagulant effects of Vitamin K Antagonists. Risk C: Monitor

Zinc Salts: May decrease serum concentration of Quinolones. Management: Give oral quinolones at several hours before (4 h for moxi- and sparfloxacin, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome-, 3 h for gemi-, and 2 h for enox-, levo-, nor-, pe- or ofloxacin or nalidixic acid) oral zinc salts. Risk D: Consider Therapy Modification

Pregnancy Considerations

Ofloxacin crosses the placenta and produces measurable concentrations in the amniotic fluid.

Based on available data, an increased risk of teratogenic effects has not been observed following ofloxacin use during pregnancy (Padberg 2014).

Serum concentrations of ofloxacin may be lower during pregnancy than in nonpregnant patients (Giamarellou 1989).

Ofloxacin is used in the management of plague (Y. pestis). Untreated infections in pregnant patients may result in hemorrhage (including postpartum hemorrhage), maternal and fetal death, preterm birth, and stillbirth. Limited data suggest maternal-fetal transmission of Y. pestis can occur if not treated. Pregnant patients should be treated for Y. pestis; parenteral antibiotics are preferred for initial treatment when otherwise appropriate. Ofloxacin is an alternative fluroquinolone recommended for use (in combination with an aminoglycoside) for treating pregnant patients with bubonic, pharyngeal, pneumonic, or septicemic plague. Ofloxacin may also be used as an alternative antibiotic for pre- and postexposure prophylaxis in pregnant patients exposed to Y. pestis (CDC [Nelson 2021]).

Breastfeeding Considerations

Ofloxacin is present in breast milk.

Following administration of ofloxacin 200 mg as a single oral dose, breast milk concentrations were similar to those in the maternal plasma.

Due to the potential for serious adverse reactions in the nursing infant, the manufacturer recommends a decision be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of treatment to the mother.

Ofloxacin is used in the management of plague (Y. pestis). The risk for transmission of Y. pestis via breast milk is considered low. Patients with pneumonic plague can breastfeed if both the mother and infant are receiving antibiotic treatment or the infant is receiving postexposure prophylaxis, considering the risk of exposure to the drug via breast milk. If the infant is not being treated, breast milk should be expressed for at least 48 hours of maternal antibiotic therapy to limit person-to-person contact with the infant. The expressed breast milk may be given to the infant. Once maternal clinical improvement is observed, direct breastfeeding may resume. Patients taking ofloxacin for the treatment of plague can decrease infant exposure via breast milk by feeding 4 to 6 hours after the dose (CDC [Nelson 2021]).

Monitoring Parameters

Monitor CBC, renal and hepatic function periodically if therapy is prolonged; signs and symptoms of disordered glucose regulation.

Mechanism of Action

Ofloxacin is a DNA gyrase inhibitor. DNA gyrase is an essential bacterial enzyme that maintains the superhelical structure of DNA. DNA gyrase is required for DNA replication and transcription, DNA repair, recombination, and transposition; bactericidal.

Pharmacokinetics (Adult Data Unless Noted)

Absorption: Well absorbed.

Distribution: Widely distributed into body tissues and fluids, including blister fluid, cervix, lung, ovary, prostatic tissue, skin, and sputum ; Vd: 2.4 to 3.5 L/kg.

Protein binding: 32%.

Bioavailability: 98%.

Half-life elimination: ~9 hours (biphasic: 4 to 5 hours [6.4 to 7.4 hours in elderly patients] and 20 to 25 hours [accounts for <5%]); prolonged with renal impairment.

Time to peak, serum: 1 to 2 hours.

Excretion: Urine: 65% to 80% (as unchanged drug); feces: 4% to 8%; <10% is metabolized.

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: Clearance is reduced in patients with CrCl <50 mL/minute.

Anti-infective considerations:

Parameters associated with efficacy: Concentration dependent; associated with AUC24/minimum inhibitory concentration (MIC): Goal: AUC24/MIC of ≥100 to 125 (Madaras-Kelly 1996; Schentag 2003; Shandil 2007). Note: In critically ill patients, some experts recommend AUC24/MIC goal ≥125 to 250 (Abdul-Aziz 2020).

Organism specific:

Pseudomonas aeruginosa: Goal: AUC24/MIC of ≥100 (Madaras-Kelly 1996).

Streptococcus pneumoniae: Goal: AUC24/MIC of ≥49 (Lister 1999).

Expected drug exposure in normal kidney function:

AUC:

Adults:

Single dose: Oral:

200 mg: 14.1 mg•hour/L.

400 mg: 28.36 to 31.4 mg•hour/L (Yuk 1991; manufacturer's labeling).

Single dose: IV:

200 mg, 30- or 60-minute infusion: 14.02 mg•hour/L (Farinotti 1988).

400 mg, 60-minute infusion: 27.1 mg•hour/L (Yuk 1991).

Multiple dose: Oral:

200 mg twice daily: 17.8 mg•hour/L (Warlich 1990).

400 mg twice daily: 41.2 to 48.1 mg•hour/L (Israel 1993; manufacturer’s labeling).

Multiple dose: IV:

200 mg twice daily, 30- or 60-minute infusion: 12.96 to 13.39 mg•hour/L (Farinotti 1988; Guay 1992).

400 mg twice daily, 60-minute infusion: 43.52 mg•hour/L (Flor 1993).

Cmax (peak):

Adults:

Single dose: Oral:

200 mg: 1.5 mg/L.

400 mg: 2.9 to 4.5 mg/L (Israel 1993; Yuk 1991).

Single dose: IV:

200 mg, 30-minute infusion: 5.28 mg/L (Farinotti 1988).

400 mg, 60-minute infusion: 4.3 mg/L (Yuk 1991).

Multiple dose: Oral:

200 mg twice daily: 2.2 to 2.96 mg/L (Warlich 1990; manufacturer's labeling).

400 mg twice daily: 4.6 to 6.5 mg/L (Israel 1993; manufacturer's labeling).

Multiple dose: IV:

200 mg twice daily, 30-minute infusion: 4 to 4.49 mg/L (Farinotti 1988).

400 mg twice daily, 60-minute infusion: 7.17 mg/L (Flor 1993).

Postantibiotic effect: Bacterial killing continues after ofloxacin concentration falls below the MIC of targeted pathogen and varies based on organism; generally 1 to 4.5 hours (Spangler 1998; Wain 2021).

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Tarivid;
  • (AR) Argentina: Floxil;
  • (AT) Austria: Tarivid;
  • (BD) Bangladesh: Flocet | Oflacin | Tariflox;
  • (BE) Belgium: Tarivid;
  • (BF) Burkina Faso: Asmoflox | Ocet | Oflomac | Quinolox | Umeflox;
  • (BG) Bulgaria: Ofloxin | Tarivid;
  • (BR) Brazil: Floxina | Floxstat | Ofloxacino | Ofloxan;
  • (CH) Switzerland: Tarivid;
  • (CI) Côte d'Ivoire: Ocet | Oflocare | Ofloxacine tm | Ofloxyl | Oflozix | Quinolox;
  • (CN) China: AN FU LE | An li | Ao fu xing | Bei li de | Kang tai bi tuo | Ofloxacin | She yue | Tarivid | Xin li tuo | Ya fu xing | Yang wei | Zan nuo xin | Zanocin;
  • (CZ) Czech Republic: Ofloxacino altan | Ofloxacino g.e.s. | Ofloxin | Tarivid;
  • (DE) Germany: Ofloxacin ratiopharm | Tarivid;
  • (DO) Dominican Republic: Floxstat | Grenis Oflo | Maxifloxina | Quinoflox;
  • (EC) Ecuador: Floxstat | Microbac | Ofloxacina | Oxiflox | Urostat;
  • (EE) Estonia: Ermofan | Medofloxine | Ofloxin | Tarivid;
  • (EG) Egypt: Kiroll | Ofloxin | Tariflox | Tarivan | Tarivid;
  • (ES) Spain: Oflovir | Ofloxacino g.e.s. | Surnox | Tarivid;
  • (ET) Ethiopia: Ofloxacine;
  • (FI) Finland: Tarivid;
  • (FR) France: Oflocet | Ofloxacine Aguettant | Ofloxacine maco pharma | Ofloxacine merck | Ofloxacine merck generiques | Ofloxacine pfizer;
  • (GB) United Kingdom: Tarivid;
  • (GR) Greece: Tabrin;
  • (HK) Hong Kong: Apo-Ofloxacin | Flovid | Gyrolf | Ofla | Ofloxal | Quotavil | Tarivid | Viotisone;
  • (HU) Hungary: Tarivid;
  • (ID) Indonesia: Betaflox | Floxika | Hexaflox | Occidal | Ofloxacin | Ofloxin | Poncoquin | Rilox | Tariflox | Tarivid | Zelavel | Zyflox;
  • (IE) Ireland: Buravid | Tarivid;
  • (IL) Israel: Ofloxacin Teva | Tarivid | Uro Tarivid;
  • (IN) India: Agroflox | Alof | Alproxen | Anzocin | Aqlox | Axaflox | Bacter | Bactorax | Bestoflox | Bidflox | Bidoflox | Bio Flo | Bioff | Boss | Cadof | Canoxcin | Covax | Curadex | Dakflo | Digaflox | Dioflox | Doact | Elox | Eufox | Exvid | Feno | Flox | Floxagen | Floxet | Floxicontin-O | Floxiquin | Floxo plus | Floxur | Foxcin | Fuxin | Galoxin | Gazflox | Genflox | Harpoon | Inflobid | Kimflox | Klof | Magof | Manocin | Max O Flox | Mexaflo | Moflox | Nicaxo | Novofran | Nuflexin | O Fane | O Quin | O-cebran | Obact | Ocin | Ocinc | Of | Ofal | Ofax | Ofcret | Off | Offmark | Ofkey | Oflabin | Oflacin | Oflact | Oflakem | Oflamed | Oflank | Oflatoon | Oflax | Oflem | Ofler | Oflin | Oflo | Oflobid | Oflocare | Oflocon | Oflodex | Oflomac | Ofloren | Oflores | Oflosen | Oflostar | Oflosun | Oflotas | Ofloter | Oflox | Ofloxain | Ofloxal | Ofloxamac | Ofloxarit | Oflozen | Ofnij | Ofo | Ofslog | Ofson | Ofuxin | Ofvista | Ofzen | Okaflox | Olaxi | Olfi | Olife | Omet | Onilox | Onofbact | Onoff | Oq | Oraflox | Oson | Otox | Ozoflox | Qubid | Quinoflox | Quinox | Riviflox | Ronflox | Srflox | Supaxin | Tariflox | Tarivid | Toflox | Troflox | Wisoflox | Zanocin | Zanoflox | Zanovid | Zenflox | Zerocin | Zo;
  • (IT) Italy: Flobacin | Oflocin;
  • (JO) Jordan: Novecin | Tarivid;
  • (KE) Kenya: Oflan | Oflo | Oflobid | Oflomac | Ofloxacin uf | Sunflox | Tarivid | Zofex;
  • (KR) Korea, Republic of: Effexin | Ofla;
  • (KW) Kuwait: Novecin | Tarivid;
  • (LB) Lebanon: Apo Oflox | Oflacin | Oflomed | Tarivid;
  • (LT) Lithuania: Ofloxin | Tarivid | Zanocin;
  • (LV) Latvia: Medofloxine | Ofloxin | Tarivid | Zanocin;
  • (MA) Morocco: Floximat | Oflocet | Oloxine | Oxiflor | Quinolox | Tarivid;
  • (MX) Mexico: Bactocin | Flonacin | Flosep | Floxil | Floxstat | Ibacnol | Ofloxacina | Ofloxacina Raam | Ofloxacino | Oxken | Quiflural | Rixivoc;
  • (MY) Malaysia: Inoflox | Medofloxine | Oflicin | Oflicin-100 | Oflicin-200 | Prifloxin | Tarivid;
  • (NG) Nigeria: Bgvid | Chazmax ofloxacin | Coravid | Drovid | Jozza | Jvi ofloxacin | Maco ofloxacin | Marley ofloxacin | Mevid | New divine ofloxacin | Offlo | Oflasyn | Oflolem | Oflomed | Ofloxalab | Ofloxamet | Oniflo | Pauco ofloxacin | Radoflox | Tatatab;
  • (NL) Netherlands: Tarivid;
  • (NO) Norway: Tarivid;
  • (PH) Philippines: Flodemex | Flotaz | Flovid | Floxy | Gyrex | Gyros | Inoflox | Itex | Lumflox | Mergexin | Oxyflox | Prozu | Qinolon | Syfloxacin | Terioxan;
  • (PK) Pakistan: A vid | Adios | Albact | Alcin | Arvid | Avocin | Axaflox | Bacteflox | Curitol | Dyramid | Ecoflox | Ecolox | Emevid | Euvid | Florax | Floxy | Fugacin | Furacin | G Vid | Geoflox | Gyrasid | Joxacin | Korvid | Lebx | Loxat | Loxpro | Lutiflox | O Quine | Ofaxin ds | Oflamed | Oflan | Oflatain | Oflaxa-Z | Oflobid | Oflocin | Ofloquin | Ofloscot | Oftin | Olax | Oracin | Oxiflox | Quinox | Qulavid | Rekoflox | Salmocin | Shaflo | T-vid | Tabroxacin | Tariflox | Taripharm | Tarivid | Tissot | Triva | Unox | Visoflox | Wiloxin | Wiloxovid | Zanacin | Zoxam;
  • (PL) Poland: Oflodinex | Tarivid | Zanocin;
  • (PR) Puerto Rico: Floxin;
  • (PT) Portugal: Bactoflox | Megasin | Oflocet | Ofloxacina | Tarivid;
  • (QA) Qatar: Novecin | Tarivid;
  • (RO) Romania: Ofloxin;
  • (RU) Russian Federation: Ashof | Flosiprin | Jeoflox | Oflo | Ofloxabol | Ofloxacin | Ofloxacin protech | Ofloxacin zentiva | Ofloxacin-akos | Ofloxacin-fpo | Ofloxin | Roflo | Tarivid | Zanocin | Zoflox;
  • (SG) Singapore: Inoflox | Tarivid;
  • (SI) Slovenia: Tarivid;
  • (SK) Slovakia: Medofloxine | Ofloxin | Tarivid;
  • (SR) Suriname: Taricin;
  • (TH) Thailand: Tarivid;
  • (TN) Tunisia: Oflo | Oflocet | Ofloject | Ofloxine;
  • (TR) Turkey: Girasid | Menefloks | Tarivid;
  • (TW) Taiwan: Tarivid;
  • (UA) Ukraine: Floksan | Geoflox | Oflobac | Ofloxacin | Ofloxacin Kmp | Ofloxin | Tarivid | Zanocin;
  • (UG) Uganda: Oflin | Oflo bkrs | Ofloxacin uf | Orav | Toflox | Z oflox | Zofex;
  • (VE) Venezuela, Bolivarian Republic of: Floxstat;
  • (VN) Viet Nam: Getzacin;
  • (ZA) South Africa: Adco-ofloxacin | Tarivid;
  • (ZM) Zambia: Evaflox | Ofloxin | Ofoxin | Ole
  1. Abdul-Aziz MH, Alffenaar JC, Bassetti M, et al; Infection section of European Society of Intensive Care Medicine (ESICM); Pharmacokinetic/pharmacodynamic and Critically Ill Patient Study Groups of European Society of Clinical Microbiology and Infectious Diseases (ESCMID); Infectious Diseases Group of International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT); Infections in the ICU and Sepsis Working Group of International Society of Antimicrobial Chemotherapy (ISAC). Antimicrobial therapeutic drug monitoring in critically ill adult patients: a position paper. Intensive Care Med. 2020;46(6):1127-1153. doi:10.1007/s00134-020-06050-1 [PubMed 32383061]
  2. Abramowicz M, “Antimicrobial Prophylaxis in Surgery,” Medical Letter on Drugs and Therapeutics, Handbook of Antimicrobial Therapy, 16th ed, New York, NY: Medical Letter, 2002.
  3. Alghasham AA and Nahata MC, “Clinical Use of Fluoroquinolones in Children,” Ann Pharmacother, 2000, 34(3):347-59. [PubMed 10917383]
  4. American Academy of Pediatrics (AAP). In: Kimberlin DW, Brady MT, Jackson MA, Long SA, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st ed. American Academy of Pediatrics; 2018.
  5. Aronoff GR, Bennett WM, Berns JS, et al. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children. 5th ed. Philadelphia, PA: American College of Physicians; 2007.
  6. Balagon MF, Cellona RV, Abalos RM, Gelber RH, Saunderson PR. The efficacy of a four-week, ofloxacin-containing regimen compared with standard WHO-MDT in PB leprosy. Lepr Rev. 2010;81(1):27-33. [PubMed 20496567]
  7. Bankhead R, Boullata J, Brantley S, et al. Enteral nutrition practice recommendations. JPEN J Parenter Enteral Nutr. 2009;33(2):122-167. doi:10.1177/0148607108330314 [PubMed 19171692]
  8. Beckwith MC, Feddema SS, Barton RG, Graves C. A guide to drug therapy in patients with enteral feeding tubes: dosage form selection and administration methods. Hosp Pharm. 2004;39(3):225-237. doi:10.1177/001857870403900308
  9. Bidell MR, Palchak M, Mohr J, Lodise TP. Fluoroquinolone and third-generation-cephalosporin resistance among hospitalized patients with urinary tract infections due to Escherichia coli: do rates vary by hospital characteristics and geographic region? Antimicrob Agents Chemother. 2016;60(5):3170-3173. doi:10.1128/AAC.02505-15 [PubMed 26926640]
  10. Blaszczyk A, Brandt N, Ashley J, et al. Crushed tablet administration for patients with dysphagia and enteral feeding: challenges and considerations. Drugs Aging. 2023;40(10):895-907. doi:10.1007/s40266-023-01056-y [PubMed 37707775]
  11. Boullata JI, Carrera AL, Harvey L, et al. ASPEN safe practices for enteral nutrition therapy. JPEN J Parenter Enteral Nutr. 2017;41(1):15-103. doi:10.1177/0148607116673053 [PubMed 27815525]
  12. Boullata JI. Guidebook on Enteral Medication Administration. American Society for Parenteral and Enteral Nutrition; 2019.
  13. Burkhardt O, Stass H, Thuss U, Borner K, Welte T. Effects of enteral feeding on the oral bioavailability of moxifloxacin in healthy volunteers. Clin Pharmacokinet. 2005;44(9):969-976. doi:10.2165/00003088-200544090-00006 [PubMed 16122283]
  14. Centers for Disease Control and Prevention, “Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2006: Fluoroquinolones No Longer Recommended for Treatment of Gonococcal Infections,” MMWR Recomm Rep, 2007, 56(14):332-6. [PubMed 17431378]
  15. Chalasani NP, Hayashi PH, Bonkovsky HL, et al. ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol. 2014;109(7):950-966. [PubMed 24935270]
  16. Chirwa M, Davies O, Castelino S, et al. United Kingdom British association for sexual health and HIV national guideline for the management of epididymo-orchitis, 2020. Int J STD AIDS. 2021;32(10):884-895. doi:10.1177/09564624211003761 [PubMed 34009058]
  17. Cohn SM, Cohn KA, Rafferty MJ, et al. Enteric absorption of ciprofloxacin during the immediate postoperative period. J Antimicrob Chemother. 1995;36(4):717-721. doi:10.1093/jac/36.4.717 [PubMed 8591948]
  18. Cohn SM, Sawyer MD, Burns GA, Tolomeo C, Milner KA. Enteric absorption of ciprofloxacin during tube feeding in the critically ill. J Antimicrob Chemother. 1996;38(5):871-876. doi:10.1093/jac/38.5.871 [PubMed 8961058]
  19. de Marie S, VandenBergh MF, Buijk SL, et al. Bioavailability of ciprofloxacin after multiple enteral and intravenous doses in ICU patients with severe gram-negative intra-abdominal infections. Intensive Care Med. 1998;24(4):343-346. doi:10.1007/s001340050577 [PubMed 9609412]
  20. Expert opinion. Senior Enteral Feeding Tube Editorial Team: Joseph I. Boullata, PharmD, RPh, CNS-S, FASPEN, FACN; Peggi A. Guenter, PhD, RN, FASPEN; Kathleen Gura, PharmD, BCNSP, FASHP, FASPEN, FPPA, FMSHP; Mark G. Klang, MS, RPh, BCNSP, PhD, FASPEN; Linda Lord, NP, ACNP-BC, CNSC, FASPEN.
  21. Farinotti R, Trouvin JH, Bocquet V, Vermerie N, Carbon C. Pharmacokinetics of ofloxacin after single and multiple intravenous infusions in healthy subjects. Antimicrob Agents Chemother. 1988;32(10):1590-1592. doi:10.1128/AAC.32.10.1590 [PubMed 3190187]
  22. Flor SC, Rogge MC, Chow AT. Bioequivalence of oral and intravenous ofloxacin after multiple-dose administration to healthy male volunteers. Antimicrob Agents Chemother. 1993;37(7):1468-1472. doi:10.1128/AAC.37.7.1468 [PubMed 8363378]
  23. Friedrich LV and Dougherty R, “Fatal Hypoglycemia Associated With Levofloxacin,” Pharmacotherapy, 2004, 24(12):1807-12. [PubMed 15585448]
  24. Frothingham R, “Glucose Homeostasis Abnormalities Associated With Use of Gatifloxacin,” Clin Infect Dis, 2005, 41(9):1269-76. [PubMed 16206101]
  25. Gavin JR 3rd, Kubin R, Choudhri S, et al, “Moxifloxacin and Glucose Homeostasis: A Pooled-Analysis of the Evidence From Clinical and Postmarketing Studies,” Drug Saf, 2004, 27(9):671-86. [PubMed 15230648]
  26. Giamarellou H, Kolokythas E, Petrikkos G, et al. "Pharmacokinetics of Three Newer Quinolones in Pregnant and Lactating Women," Ciprofloxacin: major advances in intravenous and oral quinolone therapy. Proceedings of a symposium. April 28 to 29, 1989, Naples, Florida. Am J Med. 1989; 87(5A):49S-51S. [PubMed 2589353]
  27. Graumlich JF, Habis S, Avelino RR, et al, “Hypoglycemia in Inpatients After Gatifloxacin or Levofloxacin Therapy: Nested Case-Control Study,” Pharmacotherapy, 2005, 25(10):1296-302. [PubMed 16185172]
  28. Guay DR, Opsahl JA, McMahon FG, Vargas R, Matzke GR, Flor S. Safety and pharmacokinetics of multiple doses of intravenous ofloxacin in healthy volunteers. Antimicrob Agents Chemother. 1992;36(2):308-312. doi:10.1128/AAC.36.2.308 [PubMed 1605596]
  29. Gupta K. Acute simple cystitis in adult males. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 17, 2023.
  30. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-e120. doi:10.1093/cid/ciq257 [PubMed 21292654]
  31. Hill DR, Ericsson CD, Pearson RD, et al; The practice of travel medicine: guidelines by the Infectious Diseases Society of America. Clin Inf Dis. 2006;43(12):1499-1539. [PubMed 17109284]
  32. Humphries RM, Fang FC, Aarestrup FM, Hindler JA. In vitro susceptibility testing of fluoroquinolone activity against Salmonella: recent changes to CLSI standards. Clin Infect Dis. 2012;55(8):1107-1113. doi:10.1093/cid/cis600 [PubMed 22752519]
  33. Israel D, Gillum JG, Turik M, et al. Pharmacokinetics and serum bactericidal titers of ciprofloxacin and ofloxacin following multiple oral doses in healthy volunteers. Antimicrob Agents Chemother. 1993;37(10):2193-2199. doi:10.1128/AAC.37.10.2193 [PubMed 8257144]
  34. Jacobs MR, Felmingham D, Appelbaum PC, et al. The Alexander Project 1998-2000: Susceptibility of Pathogens Isolated From Community-Acquired Respiratory Tract Infection to Commonly Used Antimicrobial Agents. J Antimicrob Chemother. 2003;52(2):229-246.
  35. Khaliq Y, Zhanel GG. Fluoroquinolone-Associated Tendinopathy: A Critical Review of the Literature. Clin Infect Dis. 2003;36(11):1404-1410. [PubMed 12766835]
  36. Koirala S, Basnyat B, Arjyal A, et al. Gatifloxacin versus ofloxacin for the treatment of uncomplicated enteric fever in Nepal: an open-label, randomized, controlled trial. PLoS Negl Trop Dis. 2013;7(10):e2523. doi:10.1371/journal.pntd.0002523 [PubMed 24282626]
  37. Lawrence KR, Adra M, Keir C. Hypoglycemia-Induced Anoxic Brain Injury Possibly Associated With Levofloxacin. J Infect. 2006;52(6):e177-e180. [PubMed 16269178]
  38. Lee CC, Lee MG, Hsieh R, et al. Oral fluoroquinolone and the risk of aortic dissection. J Am Coll Cardiol. 2018;72(12):1369-1378. doi:10.1016/j.jacc.2018.06.067 [PubMed 30213330]
  39. Lister PD, Sanders CC. Pharmacodynamics of trovafloxacin, ofloxacin, and ciprofloxacin against Streptococcus pneumoniae in an in vitro pharmacokinetic model. Antimicrob Agents Chemother. 1999;43(5):1118-1123. doi:10.1128/AAC.43.5.1118 [PubMed 10223923]
  40. Loebstein R, Addis A, Ho E, et al. Pregnancy Outcome Following Gestational Exposure to Fluoroquinolones: A Multicenter, Prospective Controlled Study. Antimicrob Agents Chemother. 1998;42(6):1336-1339. [PubMed 9624471]
  41. Luzzatto L, Ally M, Notaro R. Glucose-6-phosphate dehydrogenase deficiency. Blood. 2020;136(11):1225-1240. doi:10.1182/blood.2019000944 [PubMed 32702756]
  42. Madaras-Kelly KJ, Ostergaard BE, Hovde LB, Rotschafer JC. Twenty-four-hour area under the concentration-time curve/MIC ratio as a generic predictor of fluoroquinolone antimicrobial effect by using three strains of Pseudomonas aeruginosa and an in vitro pharmacodynamic model. Antimicrob Agents Chemother. 1996;40(3):627-632. doi:10.1128/AAC.40.3.627 [PubMed 8851583]
  43. Malone RS, Fish DN, Abraham E, et al, “Pharmacokinetics of Levofloxacin and Ciprofloxacin During Continuous Renal Replacement Therapy in Critically Ill Patients,” Antimicrob Agents Chemother, 2001, 45(10):2949-54. [PubMed 11557500]
  44. Manickam P, Nagaraju B, Selvaraj V, et al. Team of Study Investigators. Efficacy of single-dose chemotherapy (rifampicin, ofloxacin and minocycline-ROM) in PB leprosy patients with 2 to 5 skin lesions, India: randomised double-blind trial. Indian J Lepr. 2012;84(3):195-207. [PubMed 23484334]
  45. McCarty JM, Richard G, Huck W, et al; Ciprofloxacin Urinary Tract Infection Group. A randomized trial of short-course ciprofloxacin, ofloxacin, or trimethoprim/sulfamethoxazole for the treatment of acute urinary tract infection in women. Am J Med. 1999;106(3):292-299. doi:10.1016/s0002-9343(99)00026-1 [PubMed 10190377]
  46. Metlay JP, Waterer GW, Long AC, et al; American Thoracic Society; Infectious Diseases Society of America. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. doi:10.1164/rccm.201908-1581ST [PubMed 31573350]
  47. Mimoz O, Binter V, Jacolot A, et al. Pharmacokinetics and absolute bioavailability of ciprofloxacin administered through a nasogastric tube with continuous enteral feeding to critically ill patients. Intensive Care Med. 1998;24(10):1047-1051. doi:10.1007/s001340050714 [PubMed 9840238]
  48. Mohr JF, McKinnon PS, Peymann PJ, et al. A Retrospective, Comparative Evaluation of Dysglycemias in Hospitalized Patients Receiving Gatifloxacin, Levofloxacin, Ciprofloxacin, or Ceftriaxone. Pharmactherapy. 2005;25(10):1303-1309. [PubMed 16185173]
  49. Mueller BA, Brierton DG, Abel SR, Bowman L. Effect of enteral feeding with ensure on oral bioavailabilities of ofloxacin and ciprofloxacin. Antimicrob Agents Chemother. 1994;38(9):2101-2105. doi:10.1128/AAC.38.9.2101 [PubMed 7811026]
  50. Nelson CA, Meaney-Delman D, Fleck-Derderian S, et al; Contributors. Antimicrobial treatment and prophylaxis of plague: recommendations for naturally acquired infections and bioterrorism response. MMWR Recomm Rep. 2021;70(3):1-27. doi:10.15585/mmwr.rr7003a1 [PubMed 34264565]
  51. Nilsson-Ehle I, Ljungberg B. Quinolone Disposition in the Elderly: Practical Implications. Drugs Aging. 1991;1(4):279-288. [PubMed 1794020]
  52. Ofloxacin tablets [prescribing information]. Canton, MS: Larken Laboratories Inc; August 2020.
  53. Ofloxacin tablets [prescribing information]. Gujarat State, India: Cadila Pharmaceuticals Limited; September 2024.
  54. Padberg S, Wacker E, Meister R, et al. Observational cohort study of pregnancy outcome after first-trimester exposure to fluoroquinolones. Antimicrob Agents Chemother. 2014;58(8):4392-4398. [PubMed 24841264]
  55. Park-Wyllie LY, Juurlink DN, Kopp A, et al. Outpatient Gatifloxacin Therapy and Dysglycemia in Older Adults. N Engl J Med. 2006;354(13):1352-1361. [PubMed 16510739]
  56. Parry CM, Ho VA, Phuong le T, et al. Randomized controlled comparison of ofloxacin, azithromycin, and an ofloxacin-azithromycin combination for treatment of multidrug-resistant and nalidixic acid-resistant typhoid fever. Antimicrob Agents Chemother. 2007;51(3):819-825. doi:10.1128/AAC.00447-06 [PubMed 17145784]
  57. Parry CM, Vinh H, Chinh NT, et al. The influence of reduced susceptibility to fluoroquinolones in Salmonella enterica serovar Typhi on the clinical response to ofloxacin therapy. PLoS Negl Trop Dis. 2011;5(6):e1163. doi:10.1371/journal.pntd.0001163 [PubMed 21713025]
  58. Patel K, Goldman JL. Safety concerns surrounding quinolone use in children. J Clin Pharmacol. 2016;56(9):1060-1075. [PubMed 26865283]
  59. Peled Y, Friedman S, Hod M, et al. Ofloxacin During the Second Trimester of Pregnancy. DICP. 1991;25(11):1181-1182. [PubMed 1763532]
  60. Refer to manufacturer's labeling.
  61. Riddle MS, DuPont HL, Connor BA. ACG Clinical Guideline: diagnosis, treatment, and prevention of acute diarrheal infections in adults. Am J Gastroenterol. 2016;111(5):602-622. doi:10.1038/ajg.2016.126 [PubMed 27068718]
  62. Sanders WE Jr, Morris JF, Alessi P, et al. Oral ofloxacin for the treatment of acute bacterial pneumonia: use of a nontraditional protocol to compare experimental therapy with "usual care" in a multicenter clinical trial. Am J Med. 1991;91(3):261-266. doi:10.1016/0002-9343(91)90125-h [PubMed 1892146]
  63. Schentag JJ, Meagher AK, Forrest A. Fluoroquinolone AUIC break points and the link to bacterial killing rates. Part 2: human trials. Ann Pharmacother. 2003;37(10):1478-1488. doi:10.1345/aph.1C419 [PubMed 14519053]
  64. Setia MS, Shinde SS, Jerajani HR, et al. Is there a role for rifampicin, ofloxacin and minocycline (ROM) therapy in the treatment of leprosy? Systematic review and meta-analysis. Trop Med Int Health. 2011;16(12):1541-1551. [PubMed 21914093]
  65. Shandil RK, Jayaram R, Kaur P, et al. Moxifloxacin, ofloxacin, sparfloxacin, and ciprofloxacin against Mycobacterium tuberculosis: evaluation of in vitro and pharmacodynamic indices that best predict in vivo efficacy. Antimicrob Agents Chemother. 2007;51(2):576-582. doi:10.1128/AAC.00414-06 [PubMed 17145798]
  66. Spangler SK, Lin G, Jacobs MR, Appelbaum PC. Postantibiotic effect and postantibiotic sub-MIC effect of levofloxacin compared to those of ofloxacin, ciprofloxacin, erythromycin, azithromycin, and clarithromycin against 20 pneumococci. Antimicrob Agents Chemother. 1998;42(5):1253-1255. doi:10.1128/AAC.42.5.1253 [PubMed 9593160]
  67. Stevens DL, Bisno AL, Chambers HF, et all. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis. 2014;59(2):147-159. doi:10.1093/cid/ciu296 [PubMed 24947530]
  68. Stout J. Clinical manifestations, diagnosis, and treatment of plague (Yersinia pestis infection). Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 17, 2022.
  69. Szarfman A, Chen M, Blum MD. More on Fluoroquinolone Antibiotics and Tendon Rupture. N Engl J Med. 1995;332(3):193.
  70. Thalhammer F, Kletzmayr J, El Menyawi I, et al. Ofloxacin Clearance During Hemodialysis: A Comparison of Polysulfone and Cellulose Acetate Hemodialyzers. Am J Kidney Dis. 1998;32(4):642-645. [PubMed 9774127]
  71. Trotman RL, Williamson JC, Shoemaker DM, et al. Antibiotic Dosing in Critically Ill Adult Patients Receiving Continuous Renal Replacement Therapy. Clin Infect Dis. 2005;41(8):1159-1166. [PubMed 16163635]
  72. US Food and Drug Administration (FDA). FDA Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together. http://www.fda.gov/Drugs/DrugSafety/ucm511530.htm. Published May 12, 2016. Accessed November 18, 2020.
  73. US Dept. Health and Human Services. National Hansen's Disease Program: Recommended treatment regimens. http://www.hrsa.gov/hansensdisease/diagnosis/recommendedtreatment.html
  74. Villahermosa LG, Fajardo TT Jr, Abalos RM, et al. Parallel assessment of 24 monthly doses of rifampin, ofloxacin, and minocycline versus two years of World Health Organization multi-drug therapy for multi-bacillary leprosy. Am J Trop Med Hyg. 2004;70(2):197-200. [PubMed 14993633]
  75. Wain J, Simpson JA, Thi Diem Nga L, et al. Bactericidal activities and post-antibiotic effects of ofloxacin and ceftriaxone against drug-resistant Salmonella enterica serovar Typhi. J Antimicrob Chemother. 2021;76(10):2606-2609. doi:10.1093/jac/dkab215 [PubMed 34179968]
  76. Wang S and Rizvi AA, “Levofloxacin-Induced Hypoglycemia in a Nondiabetic Patient,” Am J Med Sci, 2006, 331(6):334-5. [PubMed 16775443]
  77. Warlich R, Korting HC, Schäfer-Korting M, Mutschler E. Multiple-dose pharmacokinetics of ofloxacin in serum, saliva, and skin blister fluid of healthy volunteers. Antimicrob Agents Chemother. 1990;34(1):78-81. doi:10.1128/AAC.34.1.78 [PubMed 2327762]
  78. White R, Bradnam V; British Pharmaceutical Nutrition Group. Handbook of Drug Administration via Enteral Feeding Tubes. 3rd ed. Pharmaceutical Press; 2015.
  79. Wiesenfeld H. Pelvic inflammatory disease: treatment in adults and adolescents. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed September 1, 2021.
  80. Workowski KA, Bolan GA; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2015 [published correction appears in MMWR Recomm Rep. 2015;64(33):924]. MMWR Recomm Rep. 2015;64(RR-03):1-137. [PubMed 26042815]
  81. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. doi:10.15585/mmwr.rr7004a1 [PubMed 34292926]
  82. World Health Organization (WHO). Guidelines for the management of symptomatic sexually transmitted infections. Geneva: World Health Organization; published June 2021. [PubMed 34370424]
  83. World Health Organization (WHO). WHO Expert Committee on Leprosy. World Health Organ Tech Rep Ser. 2012;(968):1-61, 1 p following 61. [PubMed 22970604]
  84. World Health Organization (WHO). WHO Expert Committee on Leprosy. World Health Organ Tech Rep Ser. 1998;874:1-43. [PubMed 9627517]
  85. Wright DH, Pietz SL, Konstantinides FN, Rotschafer JC. Decreased in vitro fluoroquinolone concentrations after admixture with an enteral feeding formulation. JPEN J Parenter Enteral Nutr. 2000;24(1):42-48. doi:10.1177/014860710002400142 [PubMed 10638471]
  86. Yuk JH, Nightingale CH, Quintiliani R, et al. Absorption of ciprofloxacin administered through a nasogastric or a nasoduodenal tube in volunteers and patients receiving enteral nutrition. Diagn Microbiol Infect Dis. 1990;13(2):99-102. doi:10.1016/0732-8893(90)90092-a [PubMed 2114955]
  87. Yuk JH, Nightingale CH, Quintiliani R, Sweeney KR. Bioavailability and pharmacokinetics of ofloxacin in healthy volunteers. Antimicrob Agents Chemother. 1991;35(2):384-386. doi:10.1128/AAC.35.2.384 [PubMed 2024973]
  88. Yuk JH, Nightingale CH, Sweeney KR, Quintiliani R, Lettieri JT, Frost RW. Relative bioavailability in healthy volunteers of ciprofloxacin administered through a nasogastric tube with and without enteral feeding. Antimicrob Agents Chemother. 1989;33(7):1118-1120. doi:10.1128/AAC.33.7.1118 [PubMed 2506806]
  89. Zacher JL and Givone DM, “False-Positive Urine Opiate Screening Associated With Fluoroquinolone Use,” Ann Pharmacother, 2004, 38:1525-28. [PubMed 15252190]
Topic 9892 Version 364.0