Ofloxacin (Ocuflox) vs. Tobramycin (Tobrex)

• Ofloxacin and Tobramycin are antibiotics used to treat bacterial infections of the eyes.
• Other forms of ofloxacin are used to treat bacterial infections such as pneumonia, bronchitis, staph infections, STDs (gonorrhea, chlamydia), urinary tract infections (UTIs), and prostate infections caused by E. coli.
• Ofloxacin and Tobramycin are different types of antibiotics. Ofloxacin is a fluoroquinolone antibiotic and Tobramycin is an aminoglycoside antibiotic.
• A brand name for ofloxacin is Ocuflox. The Floxin brand of ofloxacin has been discontinued.
• Side effects of ofloxacin and Tobramycin that are similar include stinging/burning of the eyes, temporary blurred vision, eye itching, and tearing
• Side effects of ofloxacin that are different from Tobramycin include nausea, vomiting, diarrhea, insomnia, headache, dizziness, itching, vaginitis, allergic reactions (such as hives and anaphylaxis), anxiety, euphoria, hallucinations, low or high blood sugar levels (especially in people with diabetes), and skin sensitivity to sunlight (photosensitivity)
• Side effects of Ocuflox that are different from Tobramycin include eye discomfort, redness, dryness, feeling as if something is in your eye, and sensitivity to light.
• Ofloxacin and other fluoroquinolones have been associated with tendinitis and tendon rupture, particularly the Achilles tendon.
• Side effects of Tobramycin that are different from ofloxacin include swelling of the eye.

Ofloxacin is a fluoroquinolone antibiotic used to treat bacterial infections such as pneumonia, bronchitis, staph infections, STDs (gonorrhea, chlamydia), urinary tract infections (UTIs), and prostate infections caused by E. coli. The Ocuflox brand of ofloxacin is used to treat eye infections. Other fluoroquinolone antibiotics include levofloxacin (Levaquin), ciprofloxacin (Cipro), gatifloxacin (Tequin), norfloxacin (Noroxin), moxifloxacin (Avelox), and trovafloxacin (Trovan). Ofloxacin stops the multiplication of bacteria by inhibiting the reproduction and repair of their genetic material (DNA).

Tobramycin (Tobrex) is an aminoglycoside antibiotic eye drop used to treat external infections of the eye caused by bacteria. Tobramycin kills susceptible bacteria by blocking bacterial protein synthesis. Death of susceptible bacteria occurs because of the lack of functional proteins. Tobramycin treats only bacterial eye infections and does not work for other types of eye infections.

Ofloxacin

The most common side effects of systemic ofloxacin include:

• nausea,
• vomiting,
• diarrhea,
• insomnia,
• headache,
• dizziness,
• itching, and
• vaginitis in women.

Allergic reactions have been described, such as hives and anaphylaxis (shock).

Other important side effects include symptoms of nervous system stimulation, such as:

• anxiety,
• euphoria, and
• hallucinations.

Ofloxacin may cause low or high blood sugar levels especially in people with diabetes who are taking insulin or oral hypoglycemic drugs.

Patients taking ofloxacin can develop skin sensitivity (photsensitivity) to direct sunlight and should avoid exposure to sunlight or use sun protection and sunscreens.

Ofloxacin as well as other antibiotics in the fluoroquinolone class of antibiotics, has been associated with tendinitis and even rupture of tendons, particularly the Achilles tendon. Some physicians recommend that patients discontinue vigorous exercise while they are taking fluoroquinolone antibiotics.

Ofloxacin should be used with caution in patients with central nervous system diseases such as seizures because rare seizures have been reported in patients receiving this medication.

Ofloxacin should be avoided in children and adolescents under 18 years of age, as safe use in these patients have not been established.

Many antibiotics, including ofloxacin, can alter the normal bacteria in the colon and encourage overgrowth of a bacterium responsible for the development of inflammation of the colon (Clostridium difficile, pseudomembranous colitis). Pseudomembranous colitis can cause fever, abdominal pain, diarrhea, and sometimes even shock.

Ofloxacin should not be used in patients with myasthenia gravis because it can increase muscle weakness.

Tobramycin

Side effects associated with the use of tobramycin eye drops are mostly limited to the area(s) of application. Reported side effects include:

• tearing,
• swelling of the eye, and
• itching, stinging, or burning of the eye.

Administration of eye drops may cause temporary vision problems including blurred vision. Patients should not engage in dangerous activities such as driving until their vision improves.

Although serious allergic reactions to tobramycin are unlikely, patient suspected of experiencing such a reaction must seek emergency medical help. Symptoms of a serious allergic reaction may include:

• difficulty breathing,
• swelling of the tongue,
• face, or throat, and
• severe rash.

Ofloxacin

• The usual dose for patients with normal renal function is 200 to 400 mg every 12 hours.
• Dosages require adjustment in patients with severely abnormal liver or kidney function.
• Oflaxacin is availabile as tablets: 200, 300, and 400mg.
• Ofloxacin should be stored in a closed container at 15 C - 30 C (59 F - 86 F).

Tobramycin

• For all patients ≥ 2 months of age: Instill 1-2 drops into the infected eye every 4 to 6 hours. For severe infections, instill 2 drops into the infected eye every 30 minutes to an hour until improvement and then reduce to less frequent dosing intervals as indicated. Patients using tobramycin ophthalmic solution:
• Should wash their hands thoroughly with soap and water before and after using eye drops;
• Should be advised not to wear contact lenses during treatment of active eye infections;
• Must take care to avoid touching the dropper tip to the eye while administrating eye drops;
• Should wait for at least 5 minutes between applications if other eye drop preparations also are used.

Ofloxacin

Ofloxacin reduces the elimination of theophylline, elevating blood levels of theophylline. (Theophylline is used to open airways in the treatment of asthma.) If concurrent use of ofloxacin and theophylline cannot be avoided, frequent blood tests to monitor theophylline blood levels should be performed. Ofloxacin can enhance the action of the anticoagulant (blood thinner) warfarin (Coumadin), and increase the risk of bleeding. Both high and low blood sugar levels have been reported, especially in patients with diabetes who were also receiving insulin or other medications used to lower the blood sugar. Careful monitoring of blood sugar levels is recommended. Sucralfate (Carafate), iron, multivitamins containing zinc, didanosine (Videx), as well as antacids containing calcium, magnesium, or aluminum should not be taken within two hours before or after taking ofloxacin.

Tobramycin

Information on possible drug interactions with tobramycin ophthalmic drops is not found. However, as use of therapeutic levels of tobramycin eye drops does not result into clinically meaningful levels of drug in the blood, the potential for drug interaction with other agents is relatively low. Patients using other eye drops or those with pre-existing conditions of the eye should check with their doctor or pharmacists before using tobramycin ophthalmic drops.

Ofloxacin

Ofloxacin should be avoided during pregnancy because it is secreted in breast milk and can cause adverse events in the infant.

Ofloxacin should be avoided in nursing mothers, as safe use has not been established.

Tobramycin

Most aminoglycoside antibiotics are excreted into breast milk in low concentrations. The risk for adverse effects in the nursing infant with use of ophthalmic tobramycin is considered to be low. However, consideration of the benefits of breastfeeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated infection should all be taken into account when making the decision to use tobramycin ophthalmic in nursing mother