A fixed-dose combination oral suspension containing a fluoroquinolone antibiotic (Ofloxacin) and a nitroimidazole antimicrobial (Metronidazole). This combination provides broad-spectrum coverage against both aerobic and anaerobic bacteria, as well as protozoa, making it a potent choice for mixed aerobic-anaerobic infections, particularly in the gastrointestinal and genitourinary tracts. It is widely used in the Indian context for empirical therapy of infectious diarrhea, pelvic inflammatory disease, and certain dental infections.
Adult: 10 ml (containing Ofloxacin 200mg + Metronidazole 400mg) twice daily. For severe infections, the dose can be initiated at this level. Standard course: 5-7 days, up to 10-14 days for severe/complicated infections.
Note: Shake the bottle well before use. Use the measuring cup/spoon provided. Can be taken with or without food (taking with food may minimize GI upset). Maintain adequate hydration. Complete the full prescribed course. Space doses evenly (approx. every 12 hours). Do not take antacids, sucralfate, or iron/zinc supplements within 2 hours of this medication.
Ofloxacin inhibits bacterial DNA gyrase (topoisomerase II) and topoisomerase IV, enzymes essential for DNA replication, transcription, repair, and recombination. This leads to double-stranded DNA breaks and bacterial cell death. Metronidazole is a prodrug; its nitro group is reduced by nitroreductase enzymes in anaerobic bacteria and protozoa, generating cytotoxic intermediates that damage microbial DNA, leading to strand breakage and cell death.
Pregnancy: CONTRANDICATED, especially in first trimester. Ofloxacin: Category C (risk cannot be ruled out). Metronidazole: Category B for topical use, but oral is Category C and mutagenic in bacteria. Use only if potential benefit justifies potential fetal risk. Avoid in first trimester for Metronidazole due to theoretical risk of carcinogenicity.
Driving: May impair mental alertness and physical coordination. Patients should be cautioned about driving or operating machinery if they experience dizziness, lightheadedness, or visual disturbances.
| Warfarin / Acenocoumarol | Metronidazole inhibits metabolism, increasing anticoagulant effect and risk of bleeding. INR must be closely monitored. | Major |
| Alcohol / Disulfiram | Disulfiram-like reaction with Metronidazole: severe nausea, vomiting, flushing, tachycardia, headache. | Major |
| Cimetidine | Inhibits metabolism of Metronidazole, increasing its plasma levels and risk of toxicity. | Moderate |
| Phenytoin, Phenobarbital | May increase metabolism of Metronidazole, reducing its efficacy. | Moderate |
| Oral Typhoid Vaccine | Ofloxacin may render the live vaccine ineffective. | Major |
| Corticosteroids (systemic) | Increased risk of tendon rupture with Ofloxacin. | Major |
| NSAIDs (e.g., Ibuprofen) | May increase the risk of CNS stimulation and seizures with Ofloxacin. | Moderate |
| Antacids, Sucralfate, Iron/Zinc Salts | Cationic compounds chelate Ofloxacin, drastically reducing its absorption. | Major |
| Theophylline | Ofloxacin may inhibit its metabolism, increasing theophylline levels and risk of toxicity. | Moderate |
| Cyclosporine | Ofloxacin may increase cyclosporine levels; monitor renal function. | Moderate |
Same composition (Ofloxacin (100mg/5ml) + Metronidazole (200mg/5ml)), different brands: