Pharm

Third Generation Fluoroquinolone

Third Generation Fluoroquinolone, Third Generation Quinolone, Sparfloxacin, Zagam, Gatifloxacin, Tequin

Conditions
1. Community Acquired Pneumonia
2. Refractory acute Bacterial Sinusitis (third line agent)
Activity Spectrum
1. Gram Negative Rod coverage (see other Fluoroquinolones)
  1. Enterobacteriaceae
2. Atypical Bacteria
3. Moderate Gram Positive activity

Levofloxacin (Levaquin)
1. Adult Dose 250 to 750 mg orally or IV daily
2. QT Prolongation with Levofloxacin (Levaquin)
  1. Three fold increased risk of Sudden Cardiac Death while on Levofloxacin
  2. This appears to be a class effect with most Fluoroquinolones except Ciprofloxacin
  3. Ray (2013) N Engl J Med 366(20): 1881-90 [PubMed]
Moxifloxacin (Avelox)
1. Low urine concentrations (avoid in UTI)
2. No Pseudomonas coverage
3. Highest risk Quinolone for QT Prolongation
Sparfloxacin (Zagam)
1. Associated with higher rates of Photosensitivity Reactions and was withdrawn from U.S. market in 2001
2. Low urine concentrations (avoid in UTI)
Gatifloxacin (Tequin)
1. Removed from U.S. market in 2006 due to fatalities (Hypoglycemia related)
2. Hypoglycemia with Gatifloxacin (Tequin)
  1. Has occurred in non-diabetics
  2. Contraindicated in Diabetes Mellitus