Xepi

Uses

Xepi is used for the topical treatment of impetigo due to Staphylococcus aureus or Streptococcus pyogenes in adult and pediatric patients 2 months of age and older.
Pediatric Use: The safety and effectiveness of ozenoxacin in the treatment of impetigo have been established in pediatric patients 2 months to 17 years of age. Use of ozenoxacin in pediatric patients (2 months to 17 years of age) is supported by evidence from adequate and well-controlled studies of ozenoxacin in which 251 pediatric patients received at least one dose of ozenoxacin. The median age of the patients enrolled in the clinical trials was 10 years; 3% of patients were 2 months to less than 2 years of age, 55 % of patients were 2 to less than 12 years of age, 11% of patients were 12 to less than 18 years of age, and 31 % of patients were 18 years of age or older. In these studies, the maximum dose applied was approximately 0.5 g of ozenoxacin applied twice daily for up to 5 days (i.e., up to 10 applications total). The safety profile of ozenoxacin in pediatric patients 2 months and older was similar to that of adults. The safety and effectiveness of ozenoxacin in pediatric patients younger than 2 months of age have not been established.

Geriatric Use: Clinical studies of ozenoxacin did not include sufficient numbers of subjects aged 65 and older to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients.

Xepi is also used to associated treatment for these conditions: Impetigo

How Xepi works

Xepi is a quinolone antibiotic drug. And, like most quinolones, ozenoxacin predominately executes its mechanism of action by entering into bacterial cells and acting to inhibit the bacterial DNA replication enzymes DNA gyrase A and topoisomerase IV .

As DNA gyrase A and topoisomerase IV are essential to bacterial DNA replication activities including supercoiling, supercoil relaxation, chromosomal condensation, chromosomal decatenation and more, their inhibition is the principal action of ozenoxacin's mechanism and it has been demonstrated to be bactericidal against S. aureus and S. pyogenes organisms .

Dosage

Xepi dosage

Apply a thin layer of Xepi topically to the affected area twice daily for five days. The affected area may be up to 100 cm² in adult and pediatric patients 12 years of age and older or 2% of the total body surface area and not exceeding 100 cm² in pediatric patients less than 12 years of age.

• Wash hands after applying Xepi cream.
• Xepi cream is for topical use only.
• Not for oral, ophthalmic, intranasal, or intravaginal use.
• The treated area may be covered with a sterile bandage or gauze dressing.

Side Effects

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The safety profile of Xepi was assessed in two clinical trials (Trial 1 and Trial 2) in 362 adult and pediatric patients two months of age and older with impetigo. The patients used at least one dose from a 5-day, twice a day regimen of Xepi. Control groups included 361 patients who used placebo and 152 patients who used retapamulin ointment. The median age of the patients enrolled in the clinical trials was 10 years; 3 % of patients were 2 months to less than 2 years of age, 55 % of patients were 2 to less than 12 years of age, 11 % of patients were 12 to less than 18 years of age, and 31 % of patients were 18 years of age or older. Adverse reactions (rosacea and seborrheic dermatitis) were reported in 1 adult patient treated with Xepi.

Toxicity

Xepi cream has the potential to cause rosacea and seborrheic dermatitis when administered topically on a patient. In clinical trials, only one adult patient treated with ozenoxacin cream reported such adverse reactions .

Much like other topical antibiotics, the prolonged use of ozenoxacin cream can result in the overgrowth of nonsusceptible bacteria and fungi. If such overgrowths develop into infections during therapy, discontinue use of the ozenoxacin cream and institue appropriate therapy for the infections .

Although clinical studies demonstrate negligible systemic absorption after topical administration of ozenoxacin, there are no formal available data on the use of ozenoxacin in pregnant women to inform any professional drug associated risk for use in pregnancy .

Although breastfeeding is not expected to result in exposure of the child to ozenoxacin owing to the negligible systemic absorption of ozenoxacin in humans following topical administration, no formal data are available regarding the presence of ozenoxacin in human milk and the effects of ozenoxacin on breasfed infants or on milk production .

Clinical experience with ozenoxacin cream has not identified differences in responses between elderly and younger patients .

The safety and effectiveness of ozenoxacin cream in pediatric patients 2 months and older is similar to that of adults, but the safety and effectiveness of ozenoxacin in pediatric patients younger than 2 months of age has not been formally establlished .

Long-term studies in animals to evaluate carcinogenic potential have not been conducted with ozenoxacin .

Xepi demonstrated no genotoxicity when evaluated in vitro for gene mutation and/or chromosomal effects in the Ames test, mouse lymphoma cell assay, or when evaluated in vivo in a rat micronucleus test with demonstrated systemic exposure .

Oral doses of ozenoxacin did not affect mating and fertility in male and female rats treated up to 500 mg/kg/day (about 8500 and 16,000 times respectively, the maximum human plasma concentration seen with dermal application of ozenoxacin 1% cream) .

Precaution

Potential for Microbial Overgrowth: The prolonged use of Xepi may result in overgrowth of nonsusceptible bacteria and fungi. If such infections occur during therapy, discontinue use and institute appropriate supportive measures.

Food Interaction

Volume of Distribution

Xepi undergoes negligible systemic absorption after its topical administration . Subsequently, since negligible systemic absorption of ozenoxacin was observed in clinical studies, tissue distribution has not been investigated in humans either .

Elimination Route

Four studies were performed in which varying strengths of ozenoxacin cream, up to 2% (twice the concentration of the marketed formulation), were administered to 110 patients. Three of the studies examined systemic absorption in healthy subjects and in subjects having impetigo. The studies were performed with either single or repeated application of up to 1 g ozenoxacin cream to intact or abraded skin (up to 200 cm squared surface area). No systemic absorption was seen in 84 of 86 subjects, and negligible systemic absorption was seen at the level of detection (0.489 ng/mL) in 2 subjects .

Clearance

Xepi undergoes negligible systemic absorption after its topical administration .

Elimination Route

Studies regarding elimination and excretion have not yet been investigated in humans due to the negligible systemic absorption observed in clinical studies .

Pregnancy & Breastfeeding use

Pregnancy: There are no available data on the use of ozenoxacin in pregnant women to inform a drug associated risk. Systemic absorption of ozenoxacin in humans is negligible following topical administration of ozenoxacin (up to twice the concentration of the marketed formulation). Due to the negligible systemic exposure, it is not expected that maternal use of ozenoxacin will result in fetal exposure to the drug. Animal reproduction studies were not conducted with ozenoxacin. However, toxicity studies conducted in pregnant rats and rabbits administered the oral form of ozenoxacin showed no significant adverse developmental effects (at >10,000 times the maximum human plasma concentration seen with dermal application of ozenoxacin). The estimated background risk of major birth defects and miscarriage for the indicated population are unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.

Lactation: No data are available regarding the presence of ozenoxacin in human milk, and the effects of ozenoxacin on the breastfed infant or on milk production. However, breastfeeding is not expected to result in exposure of the child to ozenoxacin due to the negligible systemic absorption of ozenoxacin in humans following topical administration of ozenoxacin. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for ozenoxacin and any potential adverse effects on the breast-fed child from ozenoxacin or from the underlying maternal condition.

Contraindication

None

Acute Overdose

Any sign or symptom of overdose, either topically or by accidental ingestion, should be treated symptomatically. No specific antidote is known.

Storage Condition

Store at 20ºC - 25ºC; excursions permitted to 15ºC to 30ºC. Keep away from light & moisture. Keep out of the reach of children.

Innovators Monograph

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