Levofloxacin

Brand Name Quixin. Class of Drug Fluoroquinolone antibacterial. Inhibition of bacterial topoisomerase IV and DNA gyrase Indications For the treatment of bacterial conjunctivitis caused by susceptible strains of the following organisms: Aerobic grampositive Corynebacterium spp.*, S. aureus, S. epidermidis, S. pneumoniae, Streptococcus (groups C/F/G), VGS. Aerobic gram-negativeAcinetobacter lwoffii*, H. influenzae, S. marcescens*. (*Efficacy for this organism was studied in fewer than ten infections.) Dosage Form Topical ophthalmic solution 0.5%. Dose Days 1 and 2: 12 drops to affected eye(s) every 2 h while awake up to eight times per day; days 37: 12 drops to affected eye(s) every 4 h while awake up to four times per day. Contraindications In patients with a history of hypersensitivity to the product or any of its components or to other quinolones. Warnings In patients receiving systemic quinolones, serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported, some following the first dose. Some reactions were accompanied by cardiovascular collapse, loss of consciousness, angioedema (including laryngeal, pharyngeal, or facial edema), airway obstruction, dyspnea, urticaria, and itching. If an allergic reaction occurs, discontinue the drug. Serious acute hypersensitivity reactions may require immediate emergency treatment. Oxygen and airway management should be administered as clinically indicated. Should not be injected subconjunctivally, nor should it be introduced directly into the anterior chamber of the eye. Adverse Reactions Systemic: quinolones have been associated with hypersensitivity reactions, even following a single dose. Discontinue use Levofl oxacin 145

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immediately and contact your physician at the first sign of a rash or allergic reaction. Most frequently reported in the overall study population were transient decreased vision, fever, foreign-body sensation, headache, transient ocular burning, ocular pain or discomfort, pharyngitis, and photophobia (approximately 13% of patients). Others: include allergic reactions, lid edema, ocular dryness, and ocular itching (less than 1% of patients). Pregnancy Category C. Drug Interactions Specific drug interaction studies have not been conducted. However, systemic administration of some quinolones has been shown to elevate plasma concentrations of theophylline, interfere with the metabolism of caffeine, enhance the effects of the oral anticoagulant warfarin and its derivatives, and has been associated with transient elevations in serum creatinine in patients receiving systemic cyclosporine concomitantly

Ofloxacin
Brand Name Ocuflox. Class of Drug Antibiotic. Bactericidal effect on susceptible bacterial cells by inhibiting DNA gyrase. Indications Bacterial conjunctivitis, bacterial corneal ulcer. Aerobes, gram-positiveS. aureus, S. epidermidis, S. pneumoniae. Aerobes, gram-negativeE. cloacae, H. influenzae, P. mirabilis, P. aeruginosa, S. marcescens. Anaerobic speciesPropionibacterium acnes. Dosage Form Topical ophthalmic drops: ofloxacin ophthalmic solution 0.3%. Dose Bacterial conjunctivitis: 12 drops every 24 h. Bacterial corneal ulcer: 12 drops every 30 min while awake. Awaken at approximately 4 and 6 h after retiring and instill 12 drops. Contraindications In patients hypersensitive to the product or any of its components. Warnings Not for injection. Serious and occasionally fatal hypersensitivity (anaphylactic) reactions, some following the first dose, have been reported in patients receiving systemic quinolones, including ofloxacin. Some reactions were accompanied by cardiovascular collapse, loss of consciousness, angioedema (including laryngeal, pharyngeal, or facial edema), airway obstruction, dyspnea, urticaria, and itching. A rare occurrence of StevensJohnson syndrome, which progressed to toxic epidermal necrolysis, was reported in a patient who was receiving topical ophthalmic ofloxacin. If an allergic reaction occurs, discontinue the drug. Serious acute hypersensitivity reactions may require immediate emergency treatment. Oxygen and airway management, including intubation, should be administered as clinically indicated. Adverse Reactions Transient ocular burning or discomfort, stinging, redness, itching, chemical conjunctivitis/keratitis, ocular/periocular/ facial edema, foreign-body sensation, photophobia, blurred vision, tearing, dryness, eye pain. Rare reports of dizziness and nausea have been received. Pregnancy Category C. Drug Interactions It is not known whether this drug is excreted in human milk following topical ophthalmic administration. Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Safety and effectiveness in infants younger than 1 year of age have not been established.

Moxifloxacin Hydrochloride
Brand Name Vigamox. Class of Drug Fluoroquinolone antibacterial. Inhibition of topoisomerase II (DNA gyrase) and topoisomerase IV. Indications For the treatment of bacterial conjunctivitis caused by susceptible strains of the following organisms: Aerobic gram-positive Corynebacterium spp*, Micrococcus luteus*, S. aureus, S. epidermidis, Staphylococcus hemolyticus, Staphylococcus hominis, Staphylococcus warneri*, S. pneumoniae, S. viridans. Aerobic gram-negativeA. lwoffii*, H. influenzae, H. parainfluenzae*. Other microorganismsC. trachomatis. (*Efficacy for this organism was studied in fewer than ten infections.) Dosage Form Topical ophthalmic solution 0.5%. Dose 1 drop three times per day for 7 days. Contraindications In patients with a history of hypersensitivity the product or any of its components or to other quinolones. Warnings Should not be injected subconjunctivally nor introduced directly into anterior chamber. Systemic use has been associated with serious and occasionally fatal anaphylactic reactions. Adverse Reactions Ocular: conjunctivitis, decreased visual acuity, dry eye, keratitis, ocular discomfort, ocular hyperemia, ocular pain, ocular pruritus, subconjunctival hemorrhage, tearing. Occurred in 16% of patients. Nonocular: included fever, increased cough, infection, otitis media, pharyngitis, rash, rhinitis. Reported in 14% of patients. Pregnancy Category C. Drug Interactions In vitro studies indicate that moxifloxacin does not inhibit CYP3A4, CYP2D6, CYP2C9, CYP2C19, or CYP1A2, indicating it is unlikely to alter the pharmacokinetics of drugs metabolized by these cytochrome P-450 isozymes.\

Ciprofloxacin Hydrochloride
Brand Name Ciloxan. Class of Drug Antibiotic. Interferes with DNA gyrase. Indications Solution: Corneal ulcerscaused by P. aeruginosa, S. marcescens*, S. aureus, S. epidermidis, S. pneumoniae, VGS*. Conjunctivitis caused by H. influenzae, S. aureus, S. epidermidis, S. pneumoniae. Ointment: bacterial conjunctivitis caused by susceptible strains of the following microorganisms: Grampositive S. aureus, S. epidermidis, S. pneumoniae, VSG; gramnegative H. influenzae. (*Efficacy for this organism was studied in fewer than ten infections.) Dosage Form Topical ophthalmic solution 0.3%. Topical ophthalmic ointment 0.3%. Dose Solution: Corneal ulcers2 drops to affected eye every 15 min for the first 6 h and then 2 drops every 30 min for the remainder of the first day. On the second day, 2 drops to affected eye hourly. On the third through 14th day, 2 drops to affected eye every 4 h. Treatment may be continued after 14 days if corneal re-epithelialization has not occurred. Bacterial conjunctivitis12 drops every 2 h while awake for 2 days, and 1 or 2 drops every 4 h while awake for the next 5 days. Ointment: 1-cm (approx. -in.) ribbon three times per day to the affected eye(s) on the first 2 days, then apply a 1-cm (approx. -in.). ribbon two times per day for the next 5 days. Ciprofloxacin Hydrochloride 43

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Contraindications In persons with a history of hypersensitivity to the product or any of its components or to any member of the quinolone class of antimicrobial agents. Warnings Serious and occasionally fatal hypersensitivity (anaphylactic) reactions, some following the first dose, have been reported in patients receiving systemic quinolone therapy. Some reactions were accompanied by cardiovascular collapse, loss of consciousness, tingling, pharyngeal or facial edema, dyspnea, urticaria, and itching. Only a few patients had a history of hypersensitivity reactions. Serious anaphylactic reactions require immediate emergency treatment with epinephrine and other resuscitation measures, including oxygen, i.v. fluids, i.v. antihistamines, corticosteroids, pressor amines, and airway management, as clinically indicated. Remove contact lenses before using. Adverse Reactions Ocular: Most frequentlocal burning or discomfort. In corneal ulcer studies with frequent administration of the drug, white crystalline precipitates were seen in approximately 17% of patients. Other reactionslid-margin crusting, crystals/scales, foreign-body sensation, itching, conjunctival hyperemia, and a bad taste (less than 10% of patients); additional events occurring in less than 1% of patients included corneal staining, keratopathy/keratitis, allergic reactions, lid edema, tearing, photophobia, corneal infiltrates, nausea, and decreased vision. In manufacturer trials, in patients with corneal ulcers, a white crystalline precipitate located in the superficial portion of the corneal defect was observed in 35 (16.6%) of 210 patients. The onset of the precipitate was within 24 h to 7 days after starting therapy. In 17 patients, resolution of the precipitate was seen in 18 days. In five patients, resolution was noted in 1013 days. In nine patients, exact resolution days were unavailable; however, at follow-up examinations 1844 days after onset of the event, complete resolution of the precipitate was noted. In three patients, outcome information was

unavailable. The precipitate did not preclude continued use of ciprofloxacin nor did it adversely affect the clinical course of the ulcer or visual outcome. Systemic: occurred at an incidence below 1% and included dermatitis, nausea, and taste perversion. Pregnancy Category C. Drug Interactions Long-term carcinogenicity studies in mice and rats have been completed. After daily oral dosing for up to 2 years, there was no evidence of any carcinogenic or tumorigenic effects in these species. Specific drug interaction studies have not been conducted with ophthalmic ciprofloxacin. However, systemic administration of some quinolones has been shown to elevate plasma concentrations of theophylline, interfere with the metabolism of caffeine, enhance the effects of the oral anticoagulant warfarin and its derivatives, and has been 44 Ciprofloxacin Hydrochloride associated with transient elevations in serum creatinine in patients receiving cyclosporine concomitantly.

Gatifloxacin
Brand Name Zymar. Class of Drug Fluoroquinolone, antibacterial. Inhibition of DNA gyrase and topoisomerase IV. Indications For the treatment of bacterial conjunctivitis caused by susceptible strains of the following organisms: Aerobic grampositive bacteriaCorynebacterium propinquum*, S. aureus, S. epidermidis, Streptococcus mitis*, S. pneumoniae. Aerobic gram-negative bacteriaH. influenzae. (*Efficacy for this organism was studied in fewer than ten infections.) 110 Gatifloxacin Dosage Form Topical ophthalmic solution 0.3%. Dose Bacterial conjunctivitis: days 1 and 2, 1 drop every 2 h to affected eye(s) while awake up to eight times per day; days 37, 1 drop up to four times per day while awake. Contraindications In patients with a history of hypersensitivity to the product or any of its components or to other quinolones. Warnings Should not be injected subconjunctivally nor introduced directly into the anterior chamber of the eye. In patients receiving systemic quinolones, including gatifloxacin, serious and occasionally fatal hypersensitivity (anaphylactic) reactions, some following the first dose, have been reported. Some reactions were accompanied by cardiovascular collapse, loss of consciousness, angioedema (including laryngeal, pharyngeal, or facial edema), airway obstruction, dyspnea, urticaria, and itching. If an allergic reaction occurs, discontinue the drug. Serious acute hypersensitivity reactions may require immediate emergency treatment. Oxygen and airway management should be administered as clinically indicated. Adverse Reactions Ophthalmic use: Most frequently reported in the overall study populationconjunctival irritation, increased lacrimation, keratitis, and papillary conjunctivitis (approximately 510% of patients). Other reported reactionschemosis, conjunctival hemorrhage, dry eye, eye discharge, eye irritation, eye pain, eyelid edema, headache, red eye, reduced visual acuity, and taste disturbance ( occurring in 14% of patients). Pregnancy Category C. Drug Interactions Specific drug interaction studies have not been conducted. However, systemic administration of some quinolones has been shown to elevate plasma concentrations of theophylline, interfere with metabolism of caffeine, enhance effects of the oral anticoagulant warfarin and its derivatives, and has been associated with transient elevations in serum creatinine in patients receiving systemic cyclosporine concomitantly.