Which topical ophthalmic fluoroquinolone is NOT approved for use in patients 1 year and older?

• A. Moxifloxacin
• B. Ciprofloxacin
• C. Gatifloxacin
• D. Levofloxacin

Answer: (D)

Age-based labeling for topical fluoroquinolones in pediatric patients is the main idea here. In ophthalmic use, many fluoroquinolones have approved indications that include children starting around 1 year of age, reflecting safety and efficacy data in that group. Levofloxacin ophthalmic solution, however, has labeling limited to adults (18 years and older) and does not include a 1-year-and-older pediatric indication. The other three options—moxifloxacin, ciprofloxacin, and gatifloxacin—have pediatric labeling that covers patients starting at 1 year of age. Therefore, the one not approved for use in patients 1 year and older is levofloxacin.