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

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