OCUFLOX Ophthalmic solution Ref.[10886] Active ingredients: Ofloxacin

Source: FDA, National Drug Code (US)  Revision Year: 2017 

2. Clinical Pharmacology

Pharmacokinetics

Serum, urine and tear concentrations of ofloxacin were measured in 30 healthy women at various time points during a ten-day course of treatment with OCUFLOX solution. The mean serum ofloxacin concentration ranged from 0.4 ng/mL to 1.9 ng/mL. Maximum ofloxacin concentration increased from 1.1 ng/mL on day one to 1.9 ng/mL on day 11 after QID dosing for 10 ½ days. Maximum serum ofloxacin concentrations after ten days of topical ophthalmic dosing were more than 1000 times lower than those reported after standard oral doses of ofloxacin.

Tear ofloxacin concentrations ranged from 5.7 to 31 mcg/g during the 40 minute period following the last dose on day 11. Mean tear concentration measured four hours after topical ophthalmic dosing was 9.2 mcg/g.

Corneal tissue concentrations of 4.4 mcg/mL were observed four hours after beginning topical ocular application of two drops of OCUFLOX ophthalmic solution every 30 minutes. Ofloxacin was excreted in the urine primarily unmodified.

Microbiology

Ofloxacin has in vitro activity against a broad range of gram-positive and gram-negative aerobic and anaerobic bacteria. Ofloxacin is bactericidal at concentrations equal to or slightly greater than inhibitory concentrations. Ofloxacin is thought to exert a bactericidal effect on susceptible bacterial cells by inhibiting DNA gyrase, an essential bacterial enzyme which is a critical catalyst in the duplication, transcription, and repair of bacterial DNA.

Cross-resistance has been observed between ofloxacin and other fluoroquinolones. There is generally no cross-resistance between ofloxacin and other classes of antibacterial agents such as beta-lactams or aminoglycosides.

Ofloxacin has been shown to be active against most strains of the following organisms both in vitro and clinically, in conjunctival and/or corneal ulcer infections (see Indications and Usage).

AEROBES, GRAM-POSITIVE AEROBES, GRAM-NEGATIVE
Staphylococcus aureus Enterobacter cloacae
Staphylococcus epidermidis Haemophilus influenzae
Streptococcus pneumoniae Proteus mirabilis
 Pseudomonas aeruginosa
 Serratia marcescens*
ANAEROBIC SPECIES:
Propionibacterium acnes  

* Efficacy for this organism was studied in fewer than 10 infections

The safety and effectiveness of OCUFLOX ophthalmic solution in treating ophthalmologic infections due to the following organisms have not been established in adequate and well-controlled clinical trials. OCUFLOX ophthalmic solution has been shown to be active in vitro against most strains of these organisms but the clinical significance in ophthalmologic infections is unknown.

AEROBES, GRAM-POSITIVE
Enterococcus faecalis Staphylococcus hominus
Listeria monocytogenes Staphylococcus simulans
Staphylococcus capitis Streptococcus pyogenes
AEROBES, GRAM-NEGATIVE
Acinetobacter calcoaceticus var. anitratus Klebsiella pneumoniae
Acinetobacter calcoaceticus var. lwoffii Moraxella (Branhamella) catarrhalis
Citrobacter diversus Moraxella lacunata
Citrobacter freundii Morganella morganii
Enterobacter aerogenes Neisseria gonorrhoeae
Enterobacter agglomerans Pseudomonas acidovorans
Escherichia coli Pseudomonas fluorescens
Haemophilus parainfluenzae Shigella sonnei
Klebsiella oxytoca  
OTHER
Chlamydia trachomatis  

Clinical Studies

Conjunctivitis

In a randomized, double-masked, multicenter clinical trial, OCUFLOX ophthalmic solution was superior to its vehicle after 2 days of treatment in patients with conjunctivitis and positive conjunctival cultures. Clinical outcomes for the trial demonstrated a clinical improvement rate of 86% (54/63) for the ofloxacin treated group versus 72% (48/67) for the placebo treated group after 2 days of therapy. Microbiological outcomes for the same clinical trial demonstrated an eradication rate for causative pathogens of 65% (41/63) for the ofloxacin treated group versus 25% (17/67) for the vehicle treated group after 2 days of therapy. Please note that microbiologic eradication does not always correlate with clinical outcome in anti-infective trials.

Corneal Ulcers

In a randomized, double-masked, multi-center clinical trial of 140 subjects with positive cultures, OCUFLOX ophthalmic solution treated subjects had an overall clinical success rate (complete re-epithelialization and no progression of the infiltrate for two consecutive visits) of 82% (61/74) compared to 80% (53/66) for the fortified antibiotic group, consisting of 1.5% tobramycin and 10% cefazolin solutions. The median time to clinical success was 11 days for the ofloxacin treated group and 10 days for the fortified treatment group.

6.6. Carcinogenesis, Mutagenesis, Impairment of Fertility

Long term studies to determine the carcinogenic potential of ofloxacin have not been conducted.

Ofloxacin was not mutagenic in the Ames test, in vitro and in vivo cytogenic assay, sister chromatid exchange assay (Chinese hamster and human cell lines), unscheduled DNA synthesis (UDS) assay using human fibroblasts, the dominant lethal assay, or mouse micronucleus assay. Ofloxacin was positive in the UDS test using rat hepatocyte, and in the mouse lymphoma assay.

In fertility studies in rats, ofloxacin did not affect male or female fertility or morphological or reproductive performance at oral dosing up to 360 mg/kg/day (equivalent to 4000 times the maximum recommended daily ophthalmic dose).

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