Pharm

Zoliflodacin

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Zoliflodacin, Nuzolvence

  • Indications
  1. Gonorrhea
    1. Uncomplicated urogenital in age >= 12 years, weight >=35 kg (77 lbs)
    2. In vitro activity against drug resistant Gonorrhea strains
  • Contraindications
  1. Age <12 years
  2. Weight <35 kg (77 lb)
  • Mechanism
  1. Spiropyrimidinetrione, a new class of Antibiotics
  2. Bactericidal Antibiotic that inhibits DNA synthesis
    1. Inhibits Bacterial type II topoisomerases (DNA gyrase and topoisomerase IV)
    2. Binds different sites than Fluoroquinolones
  • Dosing
  1. Take one dose of 3 grams (oral suspension)
  2. Taken with 60 ml water and within 15 minutes of preparation
  3. Administration instructions depends on weight
    1. Weight <50 kg: Take on empty Stomach, 1 hour before or 2 hours after eating
    2. Weight >50k: Take with food
  • Drug Interactions
  1. Moderate to strong CYP 3A4 inducers (e.g. Rifampin, Carbamazepine)
    1. Avoid using Zoliflodacin
  • Safety
  1. Unknown safety in Lactation
  2. Unknown safety in pregnancy
    1. Adverse effects in animal studies
    2. Adverse effects include if male partners take Zoliflodacin within last 3 months
  • Adverse Effects
  1. Headache (10%)
  2. Dizziness (3%)
  3. Nausea (3%)
  4. Diarrhea (2%)
  • Efficacy
  1. Less effective than Ceftriaxone and Azithromycin, or Cefixime
  2. WHO recommends only agents with 95% cure rates, which Zoliflodacin does not meet
    1. Urogenital Gonorrhea cure rate: 91%
    2. Pharyngeal Gonorrhea cure rate: 79.2% (not approved for this use)
    3. Rectal Gonorrhea cure rate: 87.3% (not approved for this use)
  • Resources
  1. Zoliflodacin (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=4beda35a-21b0-4b34-84ea-be6ea8cae50f
  • References
  1. Bayo-Awoyemi (2026) Am Fam Physician 114(3): 307-8 [PubMed]
  2. Luckey (2026) Lancet 407(10524): 147-60 [PubMed]