Dosing
CrCl > 80: 400 mg po/iv q d.
CrCl 80-50: 400 mg po/iv q d.
CrCl 50-10: 400 mg po/iv q d.
CrCl < 10: 400 mg po/iv q d.
Hemodialysis: no mention in PDR.
Peritoneal dialysis: no mention in PDR.
Important side effects
Diarrhea, nausea, dizziness, headache, peripheral neuropathy, qt interval prolongation (rare), severe hypersensitivity reactions (rare), tendon rupture (rare). Diplopia (PubMed).
Maybe retinal detachment (PubMed). Or not (PubMed). Probably for rhegmatogenous retinal detachment (PubMed).
Liver disease in the elderly (about 6 in 100,000) (PubMed).
It can double the risk of acute kidney injury (PubMed).
Arrhythmias: "Gatifloxacin use was associated with the highest rate (RR = 7.38; 95% CI, 2.30-23.70); moxifloxacin and ciprofloxacin were also associated with elevated rates of serious arrhythmia (RR = 3.30; 95% CI, 1.47-7.37 and RR = 2.15; 95% CI, 1.34-3.46, respectively)" (PubMed). Not so much with levofloxacin.
Important drug interactions
Antacids, antidiabetic agents, cisapride, class ia antiarrhythmic agents, class iii antiarrhythmic agents, corticosteroids, didanosine, erythromycin, erythromycin/sulfisoxazole, iron, mesoridazine, phenothiazines, sucralfate, thioridazine, tricyclic antidepressants, zinc, ziprasidone.
Rants and Screeds
Finally, a quinolone that is decent against Streptococci and Staphylococci.
Pearls
As with all quinolones, antacids bind the drug to prevent absorption.
Treatment of choice
Use for
A respiratory quinolone. Bronchitis, Cellulitis, community-acquired Pneumonia, Conjunctivitis, Sinusitis, Tuberculosis.
Don't use for
UTI, it is not excreted in the urine.
Class
Quinolone.
Curious Cases
Relevant links to my Medscape blog
Last update 11/29/19