Ofloxacin Ophthalmic Dosing
For ophthalmic use, ofloxacin 0.3% solution is the standard concentration, with dosing frequency varying by indication: for bacterial conjunctivitis, instill 1-2 drops every 2-4 hours while awake for 2 days, then 4 times daily for 5 additional days; for bacterial keratitis, use intensive dosing with 1-2 drops every 30 minutes to 1 hour initially, then taper based on clinical response. 1, 2
Bacterial Conjunctivitis Dosing
Standard regimen: Ofloxacin 0.3% ophthalmic solution, 1-2 drops every 2-4 hours while awake for the first 2 days, followed by 4 times daily for days 3-7 1, 3
The WHO Expert Committee endorsed topical ofloxacin as an appropriate option for bacterial conjunctivitis treatment, alongside gentamicin and tetracycline 1
Alternative simplified regimen: Twice-daily dosing (BID) has been shown equally effective as four-times-daily (QID) dosing for external ocular infections, with clinical outcomes virtually identical between groups 4
For severe bacterial conjunctivitis, consider more intensive initial dosing with drops every 5-15 minutes as a loading dose, followed by hourly applications 5
Bacterial Keratitis Dosing
Intensive initial regimen: Ofloxacin 0.3% solution, 1 drop every 30 minutes during waking hours on day 1, then every hour on days 2-4, then every 2 hours on days 5-21 2
Ofloxacin 0.3% achieved 85% complete corneal re-epithelialization in culture-positive bacterial keratitis, with average healing time of 13.7 days 2
Ofloxacin demonstrates superior corneal penetration (geometric mean 0.81 mg/kg) compared to ciprofloxacin (0.60 mg/kg) and norfloxacin (0.54 mg/kg), though ciprofloxacin has greater intrinsic potency against many pathogens 6
Systemic Dosing (Non-Ophthalmic)
For disseminated gonococcal infection: Ofloxacin 400 mg IV every 12 hours until improvement, then switch to 400 mg orally twice daily to complete at least 1 week of therapy 1
For epididymitis: Ofloxacin 300 mg orally twice daily for 10 days (contraindicated in persons ≤17 years of age) 1
For plague prophylaxis (adults): Ofloxacin 400 mg orally every 12 hours for 7 days postexposure 1
For plague prophylaxis (children): Ofloxacin 7.5 mg/kg orally every 12 hours (maximum 400 mg/dose) for 7 days 1
Important Clinical Considerations
Resistance patterns: Increasing fluoroquinolone resistance has been documented, particularly in methicillin-resistant Staphylococcus aureus (42% prevalence in staphylococcal isolates) and in patients with recent fluoroquinolone use or hospitalization 7, 5
Comparative efficacy: While levofloxacin 0.5% demonstrated statistically superior microbial eradication rates (90% vs 81%) compared to ofloxacin 0.3% for bacterial conjunctivitis, clinical cure rates were similar 3
Fourth-generation alternatives: Moxifloxacin and gatifloxacin offer better gram-positive coverage than ofloxacin, though they are not FDA-approved specifically for bacterial keratitis 7, 5
Follow-up timing: If no improvement or worsening occurs after 3-4 days of treatment, obtain culture and sensitivity testing and consider changing therapy 5
Pediatric use: Ofloxacin oral suspension is not available in the United States, limiting systemic use in young children 1