Treatment of conjunctivitis caused by susceptible Staphylococcus aureus, S. epidermidis, Streptococcus pneumoniae, Haemophilus influenzae, Enterobacter cloacae, Proteus mirabilis, or Pseudomonas aeruginosa.
Role of topical fluoroquinolones in management of uncomplicated bacterial conjunctivitis not fully elucidated; some clinicians suggest that the drugs be reserved principally for severe bacterial conjunctivitis because of potential development of quinolone resistance, and possibly, cost considerations.
Treatment of keratitis (corneal ulcers) caused by susceptible S. aureus, S. epidermidis, S. pneumoniae, Propionibacterium acnes, Ps. aeruginosa, or Serratia marcescens (designated an orphan drug by FDA for this use).
Some clinicians suggest that single-agent topical fluoroquinolone therapy be considered for initial treatment in patients with equivocal gram stain results on diagnostic corneal smear, presence of >1 organism, contact lens associated keratitis (suspected to be caused by gram-negative bacteria), or in those settings where culture and susceptibility tests are impossible or impractical.
Bacterial Otic Infections
Treatment of otitis externa caused by susceptible S. aureus, Escherichia coli, or Ps. aeruginosa.
Treatment of acute otitis media caused by susceptible S. aureus, S. pneumoniae, H. influenzae, Moraxella catarrhalis, or Ps. aeruginosa.
Treatment of chronic suppurative otitis media caused by susceptible S. aureus, P. mirabilis, or Ps aeruginosa.
Dosage and Administration
Administration
Avoid contamination of container.
Ophthalmic Administration
Apply topically to the eye as an ophthalmic solution.
Not for injection. Not for subconjunctival injection or introduction directly into anterior chamber of the eye.
For treatment of bacterial keratitis, administer around the clock for first 2 days of therapy.
Otic Administration
Instill into ear as otic solution.
For otic use only. Not for ophthalmic use. Not for injection.
Prior to administration, warm container in hand for 1–2 minutes before use to avoid dizziness associated with instillation of cold solution into ear canal.
Patient should lie with the affected ear upward and the otic preparation should be instilled into the ear canal; maintain position for 5 minutes to facilitate penetration of drops into ear canal. Repeat for opposite ear if necessary.
To administer for treatment of otitis media in pediatric patients with tympanostomy tubes, instill drops while the affected ear is upward. Pump tragus 4 times by pushing inward to facilitate penetration of drops into middle ear; maintain position 5 minutes. Repeat for opposite ear if necessary.
Dosage
Pediatric Patients
Bacterial Ophthalmic Infections
Conjunctivitis
Ophthalmic
Children≥1 year of age: 1 or 2 drops of 0.3% solution into affected eye(s) every 2–4 hours while awake for 2 days, then 1–2 drops 4 times daily for up to 5 more days.
Keratitis
Ophthalmic
Children≥1 year of age: 1 or 2 drops of 0.3% solution into affected eye(s) every 30 minutes while awake and then 4 and 6 hours after retiring, for 2 days. Beginning on the third day, instill 1 or 2 drops into affected eye(s) every hour while awake for up to an additional 4–6 days. Afterward, may instill 1 or 2 drops into affected eye(s) 4 times daily for additional 3 days or until clinical cure achieved.
Bacterial Otic Infections
Otitis Externa
Otic
Children 6 months to 13 years of age: 5 drops of 0.3% solution into canal of affected ear(s) once daily for 7 days.
Children ≥13 years of age: 10 drops of 0.3% solution into canal of affected ear(s) once daily for 7 days.
Acute Otitis Media
Otic
Children 1–12 years of age with tympanostomy tubes: 5 drops of 0.3% solution into canal of affected ear(s) twice daily for 10 days.
Chronic Suppurative Otitis Media
Otic
Children ≥12 years of age with perforated tympanic membranes: 10 drops of 0.3% solution into canal of affected ear(s) twice daily for 14 days.
Adults
Bacterial Ophthalmic Infections
Conjunctivitis
Ophthalmic
1 or 2 drops of 0.3% solution into affected eye(s) every 2–4 hours while awake for 2 days, then 1–2 drops 4 times daily for up to 5 more days.
Keratitis
Ophthalmic
1 or 2 drops of a 0.3% solution into affected eye(s) every 30 minutes while awake and then 4 and 6 hours after retiring, for 2 days. Beginning on third day, instill 1 or 2 drops into affected eye(s) every hour while awake for up to an additional 4–6 days. Afterward, may instill 1 or 2 drops into affected eye(s) 4 times daily for additional 3 days or until clinical cure achieved.
Bacterial Otic Infections
Otitis Externa
Otic
10 drops of 0.3% solution into canal of affected ear(s) once daily for 7 days.
Chronic Suppurative Otitis Media
Otic
10 drops of 0.3% solution into canal of affected ear(s) twice daily for 14 days in patients with perforated tympanic membranes.
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