Ofloxacin

Ofloxacin is a synthetic fluoroquinolone antibiotic used to treat a range of bacterial infections. It exerts bactericidal activity by inhibiting bacterial DNA gyrase and topoisomerase IV, enzymes essential for DNA replication and transcription.

The drug has broad-spectrum activity, particularly against many Gram-negative organisms such as Enterobacteriaceae, as well as some Gram-positive bacteria and atypical pathogens. It has been used for urinary tract infections, gynecologic and intra-abdominal infections, prostatitis, respiratory infections, skin and soft tissue infections, and certain sexually transmitted infections. In many settings, rising resistance has narrowed its indications.

Ofloxacin is available orally and by intravenous injection, and comparable systemic exposure is achieved with either route. It penetrates body tissues and fluids well. The elimination half-life is approximately 3.5 to 7 hours in people with normal renal function; it is primarily excreted by the kidneys, necessitating dose adjustments in renal impairment.

Common adverse effects include nausea, diarrhea, and rash. More serious risks include tendinopathy and tendon rupture, peripheral neuropathy, central nervous system effects (confusion, seizures), QT interval prolongation, and phototoxicity. It is generally avoided in pregnancy and in children due to potential effects on developing cartilage, and it should be used with caution in myasthenia gravis.

Drug interactions include reduced absorption with divalent or trivalent cations such as calcium, magnesium, iron, and aluminum-containing antacids or sucralfate. Concomitant use with certain antiarrhythmics or other QT-prolonging drugs can increase arrhythmia risk. Higher risk of adverse effects has led to more restrictive regulatory guidelines in many countries.

Ophthalmic and otic formulations are available for local use. As with other fluoroquinolones, stewardship and resistance considerations limit its use to appropriate indications.