XEPI (ozenoxacin)
SELF ADMINISTRATION
Indications for Prior Authorization:
- Topical treatment of impetigo due to Staphylococcus aureus or Streptococcus pyogenes in adult and pediatric patients 2 months of age and older
Patients must meet the following criteria for the indication(s) above:
- Patient is 2 months of age or older, AND
- Diagnosis of impetigo confirmed by chart note documentation, AND
- Patient has tried and failed a trial of mupirocin 2% ointment and 1 oral antibiotic, unless contraindicated or significant adverse effects are experienced
Dosing:
- Apply a thin layer to the affected area(s) twice daily for 5 days
Approval:
- 1 month (one tube)
Last review date: May 21, 2019