What is the best course of action for a patient experiencing abdominal burning and mild giddiness after wound debridement and dressing with ofloxacin (fluoroquinolone antibiotic) injection soak dressing?

Immediate Management of Abdominal Burning and Giddiness After Ofloxacin Soak Dressing

Stop the ofloxacin soak dressing immediately and switch to simple saline or sterile water dressings, as the patient is experiencing systemic absorption symptoms from topical fluoroquinolone application to an open wound. 1

Understanding the Problem

The symptoms of abdominal burning and giddiness are consistent with systemic absorption of ofloxacin through the debrided wound bed, which lacks the protective barrier of intact skin. This is a recognized adverse effect pattern:

• Gastrointestinal symptoms (including epigastric pain, nausea, and abdominal discomfort) occur in patients receiving systemic fluoroquinolones and can occur even with topical absorption through open wounds 2
• Dizziness is specifically mentioned in the FDA label as occurring in 0.4% of patients using ofloxacin otic solution, and the label explicitly warns that instillation of cold solution can cause dizziness 1
• The FDA label notes that systemic quinolones have been associated with hypersensitivity reactions even following a single dose, and recommends discontinuing use at the first sign of adverse reaction 1

Immediate Actions

Discontinue Ofloxacin Dressing

• Remove the current dressing and do not reapply ofloxacin-soaked dressings 1
• The FDA label states to "discontinue use immediately and contact your physician at the first sign of a rash or allergic reaction" - this principle extends to systemic symptoms 1

Switch to Appropriate Wound Care

• Use simple saline or sterile water for wound cleansing and dressing, as recommended for standard wound bed preparation 3
• Apply non-adherent dressings with a greasy emollient to maintain moisture without antimicrobial agents 4
• Perform daily wound inspection for signs of infection (purulent drainage, spreading erythema >5 cm, induration, warmth) 5, 6

Wound Management Going Forward

Appropriate Antimicrobial Strategy

• Topical antimicrobial dressings are NOT recommended for routine wound healing once infection is controlled 3, 4
• If wound infection develops (purulent drainage, significant erythema with induration, systemic signs), obtain wound cultures and consider systemic antibiotics rather than topical agents 3, 6
• For clean wounds requiring antibiotics, use cefazolin or vancomycin (if MRSA risk) systemically 5, 6

Proper Debridement Protocol

• Surgical debridement is the most important factor influencing wound healing and should be performed under copious irrigation 3, 7
• Return for repeat debridement every 24-36 hours until no further necrotic tissue is present 3
• Allow wound to heal by secondary intention with regular dressing changes after adequate debridement 6, 7

Critical Pitfalls to Avoid

• Do not use topical antibiotics on open wounds - they provide minimal benefit for established wounds and risk systemic absorption with adverse effects 3, 4
• Do not continue antimicrobial dressings when simple wound care suffices - this increases complications without improving outcomes 3
• Do not assume topical application is "safe" - open wounds allow significant systemic absorption, particularly with fluoroquinolones 1, 2

Monitoring and Follow-up

• Observe the patient for resolution of symptoms after discontinuing ofloxacin (should improve within 24-48 hours) 1
• If symptoms persist or worsen, consider other causes of abdominal pain and dizziness unrelated to the dressing 5
• Continue daily wound inspection and dressing changes with simple saline or water 3
• If infection develops (fever >38.5°C, spreading erythema, purulent drainage), obtain cultures and initiate systemic antibiotics 3, 5, 6