Gemifloxacin

General

• Type: Fluoroquinolone
• Dosage Forms: Oral (320mg)
• Common Trade Names: Factive

Adult Dosing

Pneumonia, community-acquired

• 320 mg PO q24h for at least 5 days

Chronic bronchitis, acute bacterial exacerbation

• 320 mg PO q24h x5 days

Gonoccocal infection

• 320mg PO x1 with azithromycin

Pediatric Dosing

• No current dosing

Special Populations

• Pregnancy Rating: C; potential for fetotoxicity at higher doses
• Lactation: L3; no human data available.
• Renal Dosing
  • Adult
    • CrCl <40: 160mg q24h
    • HD/PD: No supplement
  • Pediatric
    • N/A
• Hepatic Dosing
  • Adult
    • No adjustment
  • Pediatric
    • N/A

Contraindications

• Allergy to class/drug
• Myasthenia gravis
• QT prolongation
• Uncorrected electrolyte abnormaliteis

Adverse Reactions

Serious

• Anaphylaxis, hypersensitivity reaction
• C. Diff associated diarrhea
• Seizures
• Toxic psychosis, depression, suicidality
• Hyperglycemia
• Phototoxicity
• Vasulitis
• Serum sickness
• Hepatotoxicity, Nephrotoxicity
• Myelosuppression, Blood dyscrasias
• QT Prolongation, Torsades de pointes
• Peripheral neuropathy
• Tendon rupture
• Arthropathy
• Myasthenia gravis exacerbation

Common

• Diarrhea, nausea, Vomiting
• Headache, dizziness
• Rash
• Tendinitis
• Arthralgia, Myalgia
• Insomnia, anxiety, confusion

Pharmacology

• Half-life: 7h
• Metabolism: Liver minimally
• Excretion: Feces 61%, Urine 36%
• Mechanism of Action: Inhibits DNA gyrase and topoisomerase IV

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	S
	Strep. anginosus gp	S
	Enterococcus faecalis	S
	Enterococcus faecium	I
	MSSA	S
	MRSA	I
	CA-MRSA	I
	Staph. Epidermidis	S
	C. jeikeium	X1
	L. monocytogenes	S
Gram Negatives	N. gonorrhoeae	I
	N. meningitidis	X1
	Moraxella catarrhalis	S
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	S
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	S
	Enterobacter sp, AmpC pos	S
	Serratia sp	X1
	Serratia marcescens	X1
	Salmonella sp	X1
	Shigella sp	X1
	Proteus mirabilis	X1
	Proteus vulgaris	S
	Providencia sp.	X1
	Morganella sp.	X1
	Citrobacter freundii	X1
	Citrobacter diversus	X1
	Citrobacter sp.	X1
	Aeromonas sp	X1
	Acinetobacter sp.	I
	Pseudomonas aeruginosa	X1
	Burkholderia cepacia	X1
	Stenotrophomonas maltophilia	X1
	Yersinia enterocolitica	X1
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	S
	Pasteurella multocida	X1
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	S
	Mycoplasm pneumoniae	S
	Rickettsia sp	X1
	Mycobacterium avium	X1
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	R
	Prevotella melaninogenica	X1
	Clostridium difficile	X1
	Clostridium (not difficile)	X1
	Fusobacterium necrophorum	X1
	Peptostreptococcus sp.	X1

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia