XEPI (ozenoxacin)

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)