No longer available in the US due to toxicities except as an ophthalmic solution.
Dosing
CrCl > 40: 200-400 mg po/iv qd.
CrCl 80-50:
CrCl 50-10:
CrCl < 40: 400 mg load, then 200 po/iv qd.
Hemodialysis: 400 mg load, then 200 po/iv qd.
Peritoneal dialysis: 400 mg load, then 200 po/iv qd.
Important side effects
Beware ever so slightly of patients with long qt (that's an EKG finding), it can make it worse. diarrhea, nausea, dizziness, headache, hyperglycemia, hypoglycemia (PubMed), peripheral neuropathy, tendon rupture (rare), torsades de pointes (rare).
Important drug interactions
Aluminum carbonate, aluminum hydroxide, aluminum phosphate, antidiabetic agents, cisapride, class ia antiarrhythmic agents, class III antiarrhythmic agents, didanosine, digoxin, dihydroxyaluminum aminoacetate, dihydroxyaluminum sodium carbonate, erythromycin, iron, magaldrate, magnesium, mesoridazine, phenothiazines, prednisone, probenecid, quercetin, thioridazine, tricyclic antidepressants, warfarin, zinc, ziprasidone.
Rants and Screeds
Pearls
Along with moxifloxacin with it is probably preferred for respiratory infections of all kinds. All antacids prevent absorption.
Treatment of choice
Use for
As for any other quinolone. Much better streptococcal and staphylococcal mic's as compared to other quinolones. It, along with moxifloxacin, are the only two I would trust for these bacteria. Bronchitis, Cellulitis, Conjunctivitis, Gonorrhea, Otitis media, Pneumonia, Pyelonephritis, Sinusitis, Tuberculosis, UTI.
Don't use for
Class
Quinolone.
Last Update 11/26/19