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==General== | ==General== | ||
*Type: | *Type: [[Fluroquinolones]] | ||
*Dosage Forms: | *Dosage Forms: 200,300,400, topical/otic | ||
*Common Trade Names: | *Common Trade Names: Floxin, Floxin Otic | ||
==Adult Dosing== | ==Adult Dosing== | ||
===Infections, bacterial=== | |||
*200-400mg PO q12h | |||
===Infections, [[chlamydial]]=== | |||
*300mg PO q12h x 7d | |||
===[[Urethritis]], nongonococcal=== | |||
*300mg PO q12h x 7d | |||
===[[Epididymitis]]=== | |||
*300mg PO q12h x 10d | |||
===[[Typhoid fever]]=== | |||
*400mg PO q12h x 7-14d | |||
===[[Otitis Externa]]=== | |||
*5 drops in affected ear BID x 7 days<ref name="CPGENT2014">Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161 DOI: 10.1177/0194599813517659 [http://www.aepap.org/sites/default/files/otitis_externa_guia2014-rosenfeld-161-8_0.pdf PDF]</ref> | |||
**Safe with perforations | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
===[[PID]]=== | |||
*>12yrs: 400mg PO BID x 14d | |||
===[[Typhoid fever]]=== | |||
*20mg/kg BID x 10d, max 400mg/dose | |||
===[[Otitis Externa]]=== | |||
*6mo-13 yo: 5 drops in affected ear BQD x 7 days | |||
*>13 yo: 5 drops in affected ear BID x 7 days<ref name="CPGENT2014">Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161 DOI: 10.1177/0194599813517659 [http://www.aepap.org/sites/default/files/otitis_externa_guia2014-rosenfeld-161-8_0.pdf PDF]</ref> | |||
==Special Populations== | ==Special Populations== | ||
*Pregnancy: | *Pregnancy: C (risk cannot be excluded) | ||
*Lactation: | *Lactation: probably safe | ||
*Renal Dosing | *Renal Dosing | ||
**Adult | **Adult | ||
***GFR 20-50: give q24h | |||
***GFR < 20: give usual dose x1, then decrease dose 50% q24h | |||
***HD: give 100-200mg after dialysis | |||
**Pediatric | **Pediatric | ||
***specific adjustment not defined though adjustment may be required | |||
*Hepatic Dosing | *Hepatic Dosing | ||
**Adult | **Adult | ||
***cirrhosis: max 400mg/24h | |||
**Pediatric | **Pediatric | ||
***specific adjustment not defined though adjustment may be required | |||
==Contraindications== | ==Contraindications== | ||
*Allergy to class/drug | *Allergy to class/drug | ||
*myasthenia gravis | |||
*prolonged QT | |||
*history of torsades de pointes | |||
*caution if ventricular arrhythmias, bradycardia, recent MI | |||
*caution if CHF, patient > 60 | |||
*caution if history of renal, heart, lung transplant | |||
*caution in seizure disorder | |||
*caution in DM | |||
==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
*[[Anaphylaxis]] | |||
*[[Seizure]] | |||
*Phototoxicity | |||
*Superinfection | |||
*Increased ICP | |||
*Toxic psychosis | |||
*[[Vasculitis]] | |||
*Serum sickness | |||
*Hypersensitivity pneumonitis | |||
*[[QT prolongation]] | |||
*[[Torsades de pointes]] | |||
*Peripheral [[neuropathy]] | |||
*Hepatotoxicity | |||
*Nephrotoxicity | |||
*Crystalluria | |||
*Myelosuppression | |||
*Blood dyscrasias | |||
*Tendonitis or tendon rupture (black box warning) - increased risk in age >60, immunosuppressed, corticosteroid use | |||
*Myasthenia exacerbation | |||
*Severe Hypoglycemia <ref>FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions. US Food and Drug Administration. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm612995.htm. Updated July 10, 2018. Accessed Oct 22, 2018.</ref> | |||
*mental health effects | |||
===Common=== | ===Common=== | ||
*[[Nausea]]/[[vomiting]] | |||
*[[Diarrhea]] | |||
*Abnormal ECG | |||
*[[Headache]] | |||
*[[Dyspepsia]] | |||
*[[Dizziness]] | |||
*[[Vaginitis]] | |||
*Insomnia | |||
*Photosensitivity | |||
*[[Pruritus]] | |||
*Anxiety | |||
*Agitation | |||
*Tendinitis | |||
*Elevated LFTs | |||
==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: 4-8h, if GFR < 10 then 17-28h | ||
*Metabolism: | *Metabolism: liver minimally | ||
*Excretion: | *Excretion: urine primarily (70-90% unchanged), bile/feces (4-8%) | ||
*Mechanism of Action: | *Mechanism of Action: inhibits DNA gyrase and topoisomerase IV | ||
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | |||
{| class="wikitable" | |||
| align="center" style="background:#f0f0f0;"|'''Group''' | |||
| align="center" style="background:#f0f0f0;"|'''Organism''' | |||
| align="center" style="background:#f0f0f0;"|'''Sensitivity''' | |||
|- | |||
| Gram Positive||[[Strep. Group A, B, C, G]]||I | |||
|- | |||
| ||[[Strep. Pneumoniae]]||I | |||
|- | |||
| ||[[Viridans strep]]||R | |||
|- | |||
| ||Strep. anginosus gp||R | |||
|- | |||
| ||[[Enterococcus faecalis]]||U | |||
|- | |||
| ||[[Enterococcus faecium]]||R | |||
|- | |||
| ||[[MSSA]]||'''S''' | |||
|- | |||
| ||[[MRSA]]||R | |||
|- | |||
| ||[[CA-MRSA]]||X1 | |||
|- | |||
| ||[[Staph. Epidermidis]]||'''S''' | |||
|- | |||
| ||[[C. jeikeium]]||R | |||
|- | |||
| ||[[L. monocytogenes]]||R | |||
|- | |||
| Gram Negatives||[[N. gonorrhoeae]]||I | |||
|- | |||
| ||[[N. meningitidis]]||'''S''' | |||
|- | |||
| ||[[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||'''S''' | |||
|- | |||
| ||Serratia marcescens||X1 | |||
|- | |||
| ||[[Salmonella]] sp||'''S''' | |||
|- | |||
| ||[[Shigella]] sp||'''S''' | |||
|- | |||
| ||[[Proteus mirabilis]]||'''S''' | |||
|- | |||
| ||[[Proteus vulgaris]]||'''S''' | |||
|- | |||
| ||[[Providencia sp.]]||'''S''' | |||
|- | |||
| ||[[Morganella sp.]]||'''S''' | |||
|- | |||
| ||[[Citrobacter freundii]]||'''S''' | |||
|- | |||
| ||[[Citrobacter diversus]]||'''S''' | |||
|- | |||
| ||[[Citrobacter sp.]]||'''S''' | |||
|- | |||
| ||[[Aeromonas sp]]||'''S''' | |||
|- | |||
| ||[[Acinetobacter sp.]]||I | |||
|- | |||
| ||[[Pseudomonas aeruginosa]]||I | |||
|- | |||
| ||[[Burkholderia cepacia]]||R | |||
|- | |||
| ||[[Stenotrophomonas maltophilia]]||R | |||
|- | |||
| ||[[Yersinia enterocolitica]]||'''S''' | |||
|- | |||
| ||[[Francisella tularensis]]||X1 | |||
|- | |||
| ||[[Brucella sp.]]||X1 | |||
|- | |||
| ||[[Legionella sp.]]||'''S''' | |||
|- | |||
| ||[[Pasteurella multocida]]||'''S''' | |||
|- | |||
| ||[[Haemophilus ducreyi]]||X1 | |||
|- | |||
| ||[[Vibrio vulnificus]]||X1 | |||
|- | |||
| Misc||[[Chlamydophila sp]]||'''S''' | |||
|- | |||
| ||[[Mycoplasm pneumoniae]]||'''S''' | |||
|- | |||
| ||[[Rickettsia sp]]||X1 | |||
|- | |||
| ||[[Mycobacterium avium]]||X1 | |||
|- | |||
| Anaerobes||[[Actinomyces]]||I | |||
|- | |||
| ||[[Bacteroides fragilis]]||R | |||
|- | |||
| ||[[Prevotella melaninogenica]]||I | |||
|- | |||
| ||[[Clostridium difficile]]||X1 | |||
|- | |||
| ||[[Clostridium (not difficile)]]||I | |||
|- | |||
| ||[[Fusobacterium necrophorum]]||X1 | |||
|- | |||
| ||[[Peptostreptococcus sp.]]||I | |||
|} | |||
===Key=== | |||
{{Template:Antibacterial Spectra Key}} | |||
==See Also== | ==See Also== | ||
*[[Antibiotics (Main)]] | *[[Antibiotics (Main)]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Pharmacology]] | ||
[[Category:ID]] |
Latest revision as of 19:56, 22 September 2019
General
- Type: Fluroquinolones
- Dosage Forms: 200,300,400, topical/otic
- Common Trade Names: Floxin, Floxin Otic
Adult Dosing
Infections, bacterial
- 200-400mg PO q12h
Infections, chlamydial
- 300mg PO q12h x 7d
Urethritis, nongonococcal
- 300mg PO q12h x 7d
Epididymitis
- 300mg PO q12h x 10d
Typhoid fever
- 400mg PO q12h x 7-14d
Otitis Externa
- 5 drops in affected ear BID x 7 days[1]
- Safe with perforations
Pediatric Dosing
PID
- >12yrs: 400mg PO BID x 14d
Typhoid fever
- 20mg/kg BID x 10d, max 400mg/dose
Otitis Externa
- 6mo-13 yo: 5 drops in affected ear BQD x 7 days
- >13 yo: 5 drops in affected ear BID x 7 days[1]
Special Populations
- Pregnancy: C (risk cannot be excluded)
- Lactation: probably safe
- Renal Dosing
- Adult
- GFR 20-50: give q24h
- GFR < 20: give usual dose x1, then decrease dose 50% q24h
- HD: give 100-200mg after dialysis
- Pediatric
- specific adjustment not defined though adjustment may be required
- Adult
- Hepatic Dosing
- Adult
- cirrhosis: max 400mg/24h
- Pediatric
- specific adjustment not defined though adjustment may be required
- Adult
Contraindications
- Allergy to class/drug
- myasthenia gravis
- prolonged QT
- history of torsades de pointes
- caution if ventricular arrhythmias, bradycardia, recent MI
- caution if CHF, patient > 60
- caution if history of renal, heart, lung transplant
- caution in seizure disorder
- caution in DM
Adverse Reactions
Serious
- Anaphylaxis
- Seizure
- Phototoxicity
- Superinfection
- Increased ICP
- Toxic psychosis
- Vasculitis
- Serum sickness
- Hypersensitivity pneumonitis
- QT prolongation
- Torsades de pointes
- Peripheral neuropathy
- Hepatotoxicity
- Nephrotoxicity
- Crystalluria
- Myelosuppression
- Blood dyscrasias
- Tendonitis or tendon rupture (black box warning) - increased risk in age >60, immunosuppressed, corticosteroid use
- Myasthenia exacerbation
- Severe Hypoglycemia [2]
- mental health effects
Common
- Nausea/vomiting
- Diarrhea
- Abnormal ECG
- Headache
- Dyspepsia
- Dizziness
- Vaginitis
- Insomnia
- Photosensitivity
- Pruritus
- Anxiety
- Agitation
- Tendinitis
- Elevated LFTs
Pharmacology
- Half-life: 4-8h, if GFR < 10 then 17-28h
- Metabolism: liver minimally
- Excretion: urine primarily (70-90% unchanged), bile/feces (4-8%)
- Mechanism of Action: inhibits DNA gyrase and topoisomerase IV
Antibiotic Sensitivities[3]
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
See Also
References
- ↑ 1.0 1.1 Clinical Practice Guideline: Acute Otitis Externa Executive Summary. Otolaryngology -- Head and Neck Surgery 2014 150: 161 DOI: 10.1177/0194599813517659 PDF
- ↑ FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions. US Food and Drug Administration. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm612995.htm. Updated July 10, 2018. Accessed Oct 22, 2018.
- ↑ Sanford Guide to Antimicrobial Therapy 2014