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Fourth Generation Fluoroquinolone

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Fourth Generation Fluoroquinolone, Fourth Generation Quinolone, Trovafloxacin, Trovan, Gemifloxacin

  • See Also
  1. Fluoroquinolone
  2. Delafloxacin (Baxdela)
  • Indications
  1. Conditions
    1. Skin and Soft Tissue Infections
    2. Intra-abdominal Infections
  2. Activity Spectrum
    1. Gram Negative Bacteria (Enterobacteriaceae)
    2. Atypical Bacteria
    3. Staphylococcus aureus (Methicillin susceptible)
    4. Streptococci
      1. Improved coverage over Third Generation Quinolones
    5. Anaerobic Bacteria
      1. Not covered by Third Generation Quinolones
    6. Pseudomonas aeruginosa coverage varies
      1. Delafloxacin (Baxdela) has good Pseudomonas coverage
      2. Trovafloxacin (Trovan) has minimal Pseudomonas coverage
  • Mechanism
  1. See Fluoroquinolone
  • Medications
  • Active
  1. Delafloxacin (Baxdela)
    1. Indicated in acute Skin and Soft Tissue Infections
      1. Limit to resistant infections refractory to other agents
    2. Oral
      1. Delafloxacin 450 mg orally every 12 hours for 5-14 days
    3. Parenteral
      1. Delafloxacin 300 mg IV over 60 minutes every 12 hours
      2. Decrease dose to 200 mg IV every 12 hours if GFR 15-30 ml/min
      3. Transition to oral dosing when able
    4. Renal
      1. Adjust IV dose for GFR 15-30 ml/min (see above)
      2. Avoid Delafloxacin for GFR <15 ml/min (End Stage Renal Disease)
  • Medications
  • Discontinued
  1. Trovafloxacin (Trovan)
    1. Higher rates of acute liver injury lead to discontinuation in U.S. in 1999
    2. Avoid Trovafloxacin in UTI (low urine concentrations)
  2. Gemifloxacin (Factive)
    1. Uncommon adverse effects including acute liver injury lead to discontinuation in U.S.
    2. Community Acquired Pneumonia: 320 mg orally daily for 5 to 7 days
  • Adverse Effects
  1. See Fluoroquinolone
  • References
  1. King (2000) Am Fam Physician 61(9):2741-8 [PubMed]
  2. O'Donnell (2000) Infect Dis Clin North Am 14(2):489-513 [PubMed]
  3. Oliphant (2002) Am Fam Physician 65(3):455-64 [PubMed]
  4. Owens (2000) Med Clin North Am 84(6):1447-69 [PubMed]