Class: Quinolones
VA Class: AM900
Chemical Name: (±-1-Cyclopropyl-6-fluoro-1,4-dihydro-8-methoxy-7-(3-methyl-1-piperazinyl)-4-oxo-3-quinoline- carboxylic acid sesquihydrate
Molecular Formula: C19H22FN3O4
CAS Number: 112811-59-3
Brands: Tequin
Introduction
Antibacterial; 8-methoxy fluoroquinolone.1 2
Uses for Gatifloxacin
Respiratory Tract Infections
Acute bacterial sinusitis caused by Streptococcus pneumoniae or Haemophilus influenzae.1 8 12
Acute bacterial exacerbations of chronic bronchitis caused by susceptible S. pneumoniae, H. influenzae, H. parainfluenzae, Moraxella catarrhalis, or Staphylococcus aureus (oxacillin-susceptible [methicillin-susceptible] strains).1 8 11 b
Community-acquired pneumonia (CAP) caused by susceptible S. pneumoniae (including multidrug-resistant strains), H. influenzae, H. parainfluenzae, M. catarrhalis, S. aureus, Mycoplasma pneumoniae, Chlamydophila pneumoniae (formerly Chlamydia pneumoniae), or Legionella pneumophila.1 8 13 14 15 b
Skin and Skin Structure Infections
Uncomplicated skin and skin structure infections (i.e., simple abscesses, furuncles, folliculitis, wound infections, cellulitis) caused by susceptible S. aureus (oxacillin-susceptible [methicillin-susceptible] strains) or S. pyogenes (group A β-hemolytic streptococci).1 b
Urinary Tract Infections (UTIs)
Uncomplicated UTIs caused by susceptible Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis.1
Complicated UTIs caused by susceptible E. coli, K. pneumoniae, or P. mirabilis.1
Pyelonephritis caused by susceptible E. coli.1 8
Endocarditis
Alternative for treatment of native or prosthetic valve endocarditis† caused by fastidious gram-negative bacilli known as the HACEK group (Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Haemophilus aphrophilus, H. influenzae, H. parainfluenzae, H. paraphrophilus, Kingella denitrificans, K. kingae).c AHA and IDSA recommend ceftriaxone or ampicillin-sulbactam as drugs of choice,c but a fluoroquinolone (ciprofloxacin, gatifloxacin, levofloxacin, moxifloxacin) may be considered when β-lactam anti-infectives cannot be used.c Consultation with an infectious disease specialist is recommended.c
Gonorrhea
Uncomplicated urethritis and cervicitis caused by susceptible Neisseria gonorrhoeae.1
Acute, uncomplicated rectal infections caused by susceptible N. gonorrhoeae in women.1
Should not be used for treatment of gonococcal infections acquired in Asia or Pacific islands (including Hawaii); use may be inadvisable in other areas where N. gonorrhoeae with quinolone resistance has been reported (including California).18 20
Anthrax
Alternative for postexposure prophylaxis following suspected or confirmed exposure to aerosolized anthrax spores (inhalational anthrax)† when oral ciprofloxacin and oral doxycycline are unavailable.21
Alternative for treatment of inhalational anthrax† when a parenteral regimen is unavailable (e.g., supply or logistic problems because large numbers of individuals require treatment in a mass casualty setting).21
Mycobacterial Infections
Alternative for use in multiple-drug regimens for treatment of active tuberculosis† in patients with relapse, treatment failure, or Mycobacterium tuberculosis resistant to isoniazid and/or rifampin or when first-line drugs cannot be tolerated.28
Gatifloxacin Dosage and Administration
Administration
Administer orally or by slow IV infusion; not for IM, rapid IV, intrathecal, intraperitoneal, or sub-Q use.1
No dosage adjustment needed when switching from IV to oral administration, or vice versa.1
Administer once daily every 24 hours.1
Oral Administration
Administer tablets without regard to meals, including milk or dietary supplements containing calcium.1 (See Interactions: Specific Drugs.)
IV Administration
Gatifloxacin injection concentrate must be diluted prior to administration.1 (See Solution Compatibility under Stability.)
No further dilution necessary for gatifloxacin premixed injection.1
Manufacturer states that additives or other drugs should not be added to gatifloxacin solutions or infused simultaneously through the same IV line1 .
Dilution
Dilute gatifloxacin injection concentrate to concentration of 2 mg/mL with a compatible IV solution before administration (see Solution Compatibility under Stability).1 Do not use water for injection as a diluent;1 a hypotonic solution results.1
Use strict aseptic technique since drug product contains no preservative.1
Rate of Administration
Administer by IV infusion over 1 hour.1
Dosage
Adults
Respiratory Tract Infections
Oral or IV
400 mg once daily.1 Usual duration is 5 days for acute bacterial exacerbation of chronic bronchitis, 10 days for acute sinusitis, and 7–14 days for CAP.1
Skin and Skin Structure Infections
Oral or IV
400 mg once daily for 7–10 days.1
UTIs
Oral or IV
400 mg as a single dose or 200 mg once daily for 3 days in patients with uncomplicated UTIs; 400 mg once daily for 7–10 days in those with complicated UTIs or pyelonephritis.1
Gonorrhea
Oral or IV
400 mg as a single dose in men with uncomplicated urethral gonorrhea or in women with endocervical or rectal gonorrhea.1
Anthrax†
Oral
400 mg once daily for ≥60 days for postexposure prophylaxis or treatment of inhalational anthrax.21 22 23
Mycobacterial Infections†
Active Tuberculosis
Oral
400 mg once daily.28 Must be used in conjunction with other antituberculosis agents.28
Multiple-drug regimen usually given for 12–18 months when rifampin-resistant M. tuberculosis are involved; for 18–24 months when isoniazid- and rifampin-resistant strains are involved; or for 24 months when the strain is resistant to isoniazid, rifampin, ethambutol, and/or pyrazinamide.28
Special Populations
Hepatic Impairment
Dosage adjustment not necessary in patients with moderate (Child-Pugh class B) cirrhosis.1
Not studied to date in patients with severe (Child-Pugh class C) impairment;1 manufacturer makes no recommendations regarding dosage in such patients.16
Renal Impairment
Adjust dosage in patients with Clcr <40 mL/minute, including those who require hemodialysis or CAPD: initial dose of 400 mg, followed by 200 mg daily beginning on day 2 of therapy.1 Administer dose in hemodialysis patients after dialysis session.1
Dosage adjustment not required for single-dose regimen (for uncomplicated UTIs or gonorrhea) or 3-day regimen (for uncomplicated UTIs).1
Renal impairment increases risk of dysglycemia.b (See Hypoglycemia and Hyperglycemia under Cautions.)
Geriatric Patients
Select dosage with caution and closely monitor renal function because of age-related decreases in renal function.b (See Renal Impairment under Dosage and Administration.)
Cautions for Gatifloxacin
Contraindications
Known hypersensitivity to gatifloxacin, other quinolones, or any ingredient in the formulation.1
Diabetes mellitus.b
Warnings/Precautions
Warnings
Hypoglycemia and Hyperglycemia
Symptomatic hypoglycemia or hyperglycemia reported.1 Usually have occurred in patients with diabetes, but blood glucose disturbances (especially hyperglycemia) have occurred in patients without a history of diabetes.1
Serious (sometimes fatal) disturbances of glucose homeostasis (e.g., hyperosmolar nonketotic hyperglycemic coma, diabetic ketoacidosis, hypoglycemic coma, seizures, loss of consciousness) reported rarely during postmarketing surveillance.b
In addition to diabetes, risk factors for dysglycemia during gatifloxacin therapy include advanced age, renal insufficiency, and concurrent use of glucose-altering medication (especially oral hypoglycemic agents).b
Closely monitor blood glucose concentrations in patients with risk factors for developing dysglycemia.1 If signs and symptoms of hypoglycemia or hyperglycemia occur, discontinue gatifloxacin and immediately initiate appropriate therapy.1
Musculoskeletal Effects
Arthropathy and chondrodysplasia in weight-bearing joints of in immature animals reported with fluoroquinolones, including gatifloxacin.1 b Permanent lesions in cartilage reported in immature dogs; clinical relevance to humans unknown.1 Safety and efficacy not established in children and adolescents <18 years of age or in pregnant or lactating women.1
Rupture of the shoulder, hand, Achilles, or other tendons that required surgical repair or resulted in prolonged disability reported in patients receiving fluoroquinolones, including gatifloxacin.b Tendon rupture can occur during or after treatment; tendinitis or tendon rupture may occur more frequently in those receiving corticosteroids, especially geriatric patients.b
Discontinue gatifloxacin if pain, inflammation, or tendon rupture occurs.b Patient should rest and refrain from exercise until the diagnosis of tendinitis or tendon rupture excluded.b
Prolongation of QT Interval
Prolonged QT interval leading to ventricular arrhythmias, including torsades de pointes, reported with some fluoroquinolones, including gatifloxacin.1
QT interval prolongation is dose related; do not exceed recommended dosage or infusion rate.b
Increased torsades de pointes risk with advanced age (>60 years of age), female gender, underlying cardiac disease, and/or concurrent use of multiple medications.b
Avoid use in patients with prolonged QTc interval or uncorrected hypokalemia. Also avoid use in those receiving class IA (e.g., quinidine, procainamide) or class III (e.g., amiodarone, sotalol) antiarrhythmic agents.b Use with caution in patients receiving drugs that prolong QT interval (e.g., cisapride,17 erythromycin, antipsychotic agents, tricyclic antidepressants) and in patients with ongoing proarrhythmic conditions, such as clinically important bradycardia or acute myocardial ischemia.1
CNS Effects
Seizures, increased intracranial pressure, and psychoses reported with fluoroquinolones, including gatifloxacin.1 CNS stimulation leading to tremors, restlessness, lightheadedness, confusion, hallucinations, paranoia, depression, nightmares, insomnia, nervousness, agitation, or anxiety also reported.1
Use with caution in patients with known or suspected CNS disorders (e.g., severe cerebral arteriosclerosis, epilepsy) or other risk factors predisposing to seizures.1
If CNS effects occur, discontinue gatifloxacin and institute appropriate measures.1
Peripheral Neuropathy
Sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias, and weakness reported with fluoroquinolones.b
Discontinue gatifloxacin if symptoms of neuropathy (e.g., pain, burning, tingling, numbness, and/or weakness) occur.b
Superinfection/Clostridium difficile-associated Colitis
Possible emergence and overgrowth of nonsusceptible bacteria or fungi.1
Consider Clostridium difficile-associated diarrhea and colitis (antibiotic-associated pseudomembranous colitis) if diarrhea develops and manage accordingly.1
Sensitivity Reactions
Hypersensitivity Reactions
Serious and occasionally fatal hypersensitivity and/or anaphylactic reactions reported in patients receiving fluoroquinolones.1 These reactions may occur with first dose.1
Some hypersensitivity reactions have been accompanied by cardiovascular collapse, hypotension or shock, seizures, loss of consciousness, tingling, angioedema (e.g., edema or swelling of the tongue, larynx, throat, or face), airway obstruction (e.g., bronchospasm, shortness of breath, acute respiratory distress), urticaria, pruritus, and other severe skin reactions.1
In addition, other possible severe and potentially fatal reactions (may be hypersensitivity reactions or of unknown etiology) have been reported most frequently after multiple doses.1 These include fever, rash or other severe dermatologic reactions (e.g., toxic epidermal necrolysis, Stevens-Johnson syndrome), vasculitis, arthralgia, myalgia, serum sickness, allergic pneumonitis, interstitial nephritis, acute renal insufficiency or failure, hepatitis, jaundice, acute hepatic necrosis or failure, anemia (including hemolytic and aplastic), thrombocytopenia (including thrombotic thrombocytopenic purpura), leukopenia, agranulocytosis, pancytopenia, and/or other hematologic effects.1
Discontinue gatifloxacin at first appearance of rash or any other sign of hypersensitivity.1 Institute appropriate therapy as indicated (e.g., epinephrine, corticosteroids, and maintenance of an adequate airway and oxygen).1
Photosensitivity Reactions
Phototoxicity reported with some other quinolones.1 Potential for photosensitivity reaction may be lower with gatifloxacin than with some other fluoroquinolones (e.g., ciprofloxacin, levofloxacin).1
Avoid excessive sunlight or artificial UV light (e.g., tanning beds).1
General Precautions
Selection and Use of Anti-infectives
To reduce development of drug-resistant bacteria and maintain effectiveness of gatifloxacin and other antibacterials, use only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.b
When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing.b In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.b
Specific Populations
Pregnancy
Category C.1
Lactation
Distributed into milk in rats.1 Use with caution.1 16
Pediatric Use
Safety and efficacy not established in children <18 years of age.1
Geriatric Use
No substantial differences in safety and efficacy relative to younger adults, but increased sensitivity cannot be ruled out.1
Patients ≥65 years of age with unrecognized diabetes, age-related decreases in renal function, underlying medical problems, or receiving concomitant therapy associated with alterations of blood glucose concentration may be at particular risk for serious dysglycemia.a (See Hypoglycemia and Hyperglycemia under Cautions.)
Age-related decline in renal function may increase risk of adverse reactions.1
Hepatic Impairment
Effects of severe hepatic impairment on gatifloxacin pharmacokinetics not determined.1 Use with caution.1
Renal Impairment
Decreased clearance.1 Dosage adjustment recommended.1 (See Renal Impairment under Dosage and Administration.)
Renal impairment increases risk of dysglycemia.b (See Hypoglycemia and Hyperglycemia under Cautions.)
Common Adverse Effects
Nausea, vaginitis, redness at injection site, diarrhea, headache, dizziness.1
Interactions for Gatifloxacin
Does not inhibit CYP isoenzymes 3A4, 2D6, 2C9, 2C19, or 1A2 in vitro and is not an enzyme inducer.1 Pharmacokinetic interactions with drugs metabolized by CYP isoenzymes unlikely.1
Drugs Affecting Glucose Metabolism
Potential pharmacologic interaction (possible additive hypoglycemic or hyperglycemic effect); monitor blood glucose.a (See Hypoglycemia and Hyperglycemia under Cautions.)
Drugs That Prolong QT Interval
Potential pharmacologic interaction (additive effect on QT interval prolongation).1 (See Prolongation of QT Interval under Cautions.)
Specific Drugs
Drug | Interaction | Comments |
|---|---|---|
Antacids (aluminum- or magnesium-containing) | Decreased absorption of gatifloxacin1 | Administer gatifloxacin at least 4 hours before such antacids1 |
Antacids (calcium-containing); calcium supplements, milk | No clinically important pharmacokinetic interactions 1 | |
Antidiabetic agents (e.g., glyburide) | Hypoglycemia and hyperglycemia reportedb Glyburide: Pharmacokinetic interaction unlikely1 | Closely monitor blood glucose; discontinue gatifloxacin and initiate appropriate therapy if hypoglycemia or hyperglycemia occurs1 |
Didanosine | Decreased absorption of gatifloxacin with buffered didanosine preparations1 16 | Administer gatifloxacin at least 4 hours before buffered didanosine preparations1 16 |
Digoxin | Potential increase in serum digoxin concentration and toxicity1 | Monitor for digoxin toxicity; determine serum digoxin concentrations and adjust digoxin dosage as appropriate1 |
Iron preparations | Decreased absorption of gatifloxacin1 | Administer gatifloxacin at least 4 hours before ferrous sulfate and dietary supplements containing iron1 |
Multivitamins and mineral supplements | Decreased absorption of gatifloxacin1 | Administer gatifloxacin at least 4 hours before supplements containing zinc, magnesium, or iron1 |
NSAIAs | Possible increased risk of CNS stimulation, seizures1 | |
Omeprazole | Pharmacokinetic interaction unlikelyb | |
Probenecid | Increased systemic exposure to gatifloxacin1 | |
Sucralfate | Potential pharmacokinetic interaction16 | |
Warfarin | Potential for enhanced warfarin effect1 16 | Careful monitoring recommended1 |
Gatifloxacin Pharmacokinetics
Absorption
Bioavailability
Well absorbed from the GI tract following oral administration.1 40 Absolute bioavailability is 96%.1 37 41 When administered orally in fasting individuals, peak plasma concentrations usually occur 1–2 hours following a dose.1 b
Pharmacokinetics are similar after oral or IV (1-hour infusion) administration.1 41
Food
Administration with food does not affect peak plasma concentration or extent or rate of absorption.39
Distribution
Extent
Rapidly and widely distributed into most body tissues and fluids.1 37 38 41
Distributed into milk in rats; not known whether distributed into milk in humans.1
Plasma Protein Binding
Approximately 20%.1 41
Elimination
Metabolism
Undergoes limited biotransformation.1
Elimination Route
Excreted principally in urine as unchanged drug;1 37 38 41 <1% of a dose is excreted in urine as metabolites,1 and 5% is recovered in feces as unchanged drug.1 40
Half-life
7–14 hours.1 37 40
Special Populations
In patients with moderate to severe renal insufficiency, clearance is decreased and systemic exposure is increased.1
Stability
Storage
Oral
Tablets
Tightly sealed containers at 25°C (may be exposed to 15–30°C).1
Parenteral
Injection Concentrate for IV infusion
25°C (may be exposed to 15–30°C).1
Following dilution to concentration of 2 mg/mL with compatible IV fluid, solution is stable for 14 days at room temperature (20–25°C) or under refrigeration (2–8°C).1
Following dilution to concentration of 2 mg/mL with compatible IV fluid (except 5% sodium bicarbonate injection), solution may be stored for up to 6 months at -25 to -10°C.1 Thaw at controlled room temperature;1 stable for 14 days at room temperature or under refrigeration after thawing.1 Do not refreeze.1
Premixed Injection for IV infusion
25°C (may be exposed to 15–30°C);1 do not freeze.1
Compatibility
For information on systemic interactions resulting from concomitant use, see Interactions.
Parenteral
Solution Compatibility
For dilution of gatifloxacin injection concentrate:
Compatible1 g |
|---|
Dextrose 5% in Ringer’s injection, lactated |
Dextrose 5% in sodium chloride 0.45% with potassium chloride 20 mEq/L |
Dextrose 5% in sodium chloride 0.9% |
Dextrose 5% in water |
Plasma-Lyte 56 and dextrose 5% |
Sodium bicarbonate 5% |
Lactated Ringer’s and dextrose 5% |
Sodium bicarbonate 5% |
Sodium chloride 0.9% |
Sodium lactate (1/6)M |
Drug Compatibility
Compatible |
|---|
Acyclovir sodium |
Alfentanil HCl |
Amikacin sulfate |
Aminophylline |
Ampicillin sodium |
Ampicillin sodium-sulbactam sodium |
Aztreonam |
Bretylium tosylate |
Buprenorphine HCl |
Butorphanol tartrate |
Calcium chloride |
Calcium gluconate |
Carboplatin |
Cefazolin sodium |
Cefotetan disodium |
Ceftazidime |
Ceftizoxime sodium |
Ceftriaxone sodium |
Chlorpromazine HCl |
Cimetidine HCl |
Cisplatin |
Clindamycin phosphate |
Co-trimoxazole |
Cyclophosphamide |
Cyclosporine |
Cytarabine |
Dexamethasone sodium phosphate |
Dexmedetomidine HCl |
Digoxin |
Diphenhydramine HCl |
Dobutamine HCl |
Dopamine HCl |
Doxorubicin HCl |
Droperidol |
Enalaprilat |
Esmolol HCl |
Etoposide phosphate |
Famotidine |
Fenoldopam mesylate |
Fentanyl citrate |
Fluconazole |
Fluorouracil |
Ganciclovir sodium |
Gemcitabine HCl |
Gentamicin sulfate |
Granisetron HCl |
Haloperidol lactate |
Hydrocortisone sodium succinate |
Hydromorphone HCl |
Hydroxyzine HCl |
Ifosfamide |
Imipenem-cilastatin sodium |
Labetalol HCl |
Leucovorin calcium |
Lidocaine HCl |
Lorazepam |
Magnesium sulfate |
Mannitol |
Meperidine HCl |
Mesna |
Methotrexate sodium |
Methylprednisolone sodium succinate |
Metoclopramide HCl |
Metronidazole |
Midazolam HCl |
Mitoxantrone HCl |
Morphine sulfate |
Nalbuphine HCl |
Naloxone HCl |
Nicardipine HCl |
Nitroglycerin |
Ondansetron HCl |
Paclitaxel |
Pentamidine isethionate |
Pentobarbital sodium |
Phenobarbital sodium |
Potassium chloride |
Prochlorperazine edisylate |
Promethazine HCl |
Propranolol HCl |
Ranitidine HCl |
Remifentanil HCl |
Sodium bicarbonate |
Sodium phosphates |
Sufentanil citrate |
Theophylline |
Ticarcillin disodium |
Ticarcillin disodium-clavulanate potassium |
Tobramycin sulfate |
Trimethoprim-sulfamethoxazole |
Vecuronium bromide |
Verapamil HCl |
Vinblastine sulfate |
Vincristine sulfate |
Vinorelbine tartrate |
Zidovudine |
Incompatible |
Amphotericin B |
Amphotericin B cholesteryl sulfate complex |
Cefoperazone sodium |
Cefoxitin sodium |
Diazepam |
Furosemide |
Heparin sodium |
Phenytoin sodium |
Piperacillin sodium-tazobactam sodium |
Potassium phosphates |
Vancomycin HCl |
Actions
Like other fluoroquinolone antibacterials, gatifloxacin inhibits bacterial DNA gyrase and topoisomerase IV.1 2 29
Spectrum of activity includes gram-positive aerobic bacteria, some gram-negative bacteria, a few anaerobic bacteria, and some other organisms (e.g., Mycobacterium, Chlamydia, Mycoplasma).1
More active in vitro than ciprofloxacin or levofloxacin against Streptococcus pneumoniae (including penicillin-resistant strains) and anaerobic bacteria (i.e., Clostridium and Bacteroides),3 6 7 while retaining in vitro activity of ciprofloxacin and levofloxacin against gram-negative organisms3 6 and etiologic agents of atypical pneumonia (e.g., C. pneumoniae, M. pneumoniae, Legionella).3
Gram-positive aerobes: Active in vitro and in clinical infections against S. aureus (oxacillin-susceptible [methicillin-susceptible] strains only),1 b S. pneumoniae (including multidrug-resistant strains),1 b and S. pyogenes (group A β-hemolytic streptococci).1 Also active in vitro against some other staphylococci (e.g., S. epidermidis, S. saprophyticus) and some other streptococci (e.g., S. agalactiae [group B streptococci], S. pneumoniae [penicillin-resistant strains], viridans streptococci).1
Gram-negative aerobes: Active in vitro and in clinical infections against E. coli,1 H. influenzae,1 H. parainfluenzae,1 K. pneumoniae,1 M. catarrhalis,1 N. gonorrhoeae,1 and P. mirabilis.1 Also active in vitro against some strains of Acinetobacter, Citrobacter, Enterobacter, K. oxytoca, Morganella, and P. vulgaris.1
Other organisms: Active in vitro and in clinical infections against Chlamydophila pneumonia (formerly Chlamydia pneumoniae),1 L. pneumophila,1 M. pneumoniae,1 and M. tuberculosis.30 32
Advice to Patients
Advise patients that antibacterials (including gatifloxacin) should only be used to treat bacterial infections and not used to treat viral infections (e.g., the common cold).b
Importance of completing full course of therapy, even if feeling better after a few days.b
Advise patients that skipping doses or not completing the full course of therapy may decrease effectiveness and increase the likelihood that bacteria will develop resistance and will not be treatable with gatifloxacin or other antibacterials in the future.b
Importance of taking gatifloxacin at least 4 hours before multivitamins containing iron, magnesium, or zinc; aluminum- or magnesium-containing antacids; or didanosine chewable/dispersible buffered tablets, buffered powder for oral solution, or pediatric powder for oral solution prepared as an admixture with antacid.1 16
Importance of notifying clinician of persistent or worsening symptoms of infection.1
Potential for gatifloxacin to impair mental alertness or physical coordination; need for caution when operating machinery or driving a motor vehicle until effects of drug on individual are known.1 16
Potential for gatifloxacin to cause other CNS effects, including confusion, tremor, hallucinations, and depression.b
Importance of informing clinician if medical history includes palpitations, convulsions, or fainting spells or if any of these events occur during therapy.1
Importance of discontinuing therapy and of informing clinician if an allergic or hypersensitivity reaction occurs.1
Potential for hypoglycemia or hyperglycemia, usually in patients with diabetes or in patients at risk for dysglycemia, but also in those without diabetes.b Importance of monitoring blood sugar concentrations.b Importance of initiating appropriate therapy immediately, discontinuing gatifloxacin, and contacting clinician if symptoms of high or low blood sugar occur.b (See Hypoglyecemia and Hyperglycemia under Cautions.)
Importance of informing clinician of personal or family history of QT interval prolongation or proarrhythmic conditions (e.g., hypokalemia, bradycardia, recent myocardial ischemia).1 b
Importance of discontinuing therapy and consulting clinician if symptoms of peripheral neuropathy (e.g., pain, burning, tingling, numbness, and/or weakness) develop.b
Advise patients of risk of adverse musculoskeletal effects and importance of discontinuing gatifloxacin, resting, refraining from exercise, and consulting clinician if pain, inflammation, or rupture of a tendon occurs.1
Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs, especially drugs that may affect the QT interval (e.g., cisapride, erythromycin, antipsychotic agents, tricyclic antidepressants), antiarrhythmic agents (e.g., amiodarone, quinidine, procainamide, sotalol), diuretics (e.g., furosemide, hydrochlorothiazide), or drugs that may affect blood sugar concentrations.1 b
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1
Importance of advising patients of other important precautionary information.1 (See Cautions.)
Preparations
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Oral | Tablets, film-coated | 200 mg | Tequin | Bristol-Myers Squibb |
400 mg | Tequin | Bristol-Myers Squibb | ||
Parenteral | For injection concentrate, for IV infusion | 10 mg/mL (400 mg) | Tequin Injection | Bristol-Myers Squibb |
Injection, for IV infusion | 2 mg/mL (200 and 400 mg) in 5% dextrose | Tequin Injection Premixed (in flexible containers) | Bristol-Myers Squibb |
Disclaimer
This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.
The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.
AHFS Drug Information. © Copyright, 1959-2010, Selected Revisions June 2006. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
† Use is not currently included in the labeling approved by the US Food and Drug Administration.
References
1. Bristol-Myers Squibb Company. Tequin (gatifloxacin) tablets and injection prescribing information. Princeton, NJ; 2002 Dec.
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3. Blondeau JM. Expanded activity and utility of the new fluoroquinolones: a review. Clin Ther. 1999; 21:3-40. [IDIS 424194] [PubMed 10090423]
4. Nakashima M, Uematsu T, Kosuge K et al. Single- and multiple-dose pharmacokinetics of AM-1155, a new 6-fluoro-8-methoxy quinolone, in humans. Antimicrob Agents Chemother. 1995; 39:2635-40. [IDIS 358702] [PubMed 8592993]
5. Lober S, Ziege S, Rau M et al. Pharmacokinetics of gatifloxacin and interaction with an antacid containing aluminum and magnesium. Antimicrob Agents Chemother. 1999; 43:1067-71. [IDIS 426804] [PubMed 10223915]
6. Bauernfeind A. Comparison of the antibacterial activities of the quinolones Bay 12-8039, gatifloxacin (AM-1155), trovafloxacin, clinafloxacin, levofloxacin and ciprofloxacin. J Antimicrob Chemother. 1997; 40:639-51. [IDIS 398240] [PubMed 9421311]
7. Blondeau JM. A review of the comparative in-vitro activities of 12 antimicrobial agents, with a focus on five new ’respiratory quinolones’. J Antimicrob Chemother. 1999; 43(Suppl):1B-11B.
8. Perry CM, Barman Balfour JA, Lamb HM. Gatifloxacin. Drugs. 1999; 58:683-96. [PubMed 10551438]
9. Bayer Corporation. Avelox (moxifloxacin) tablets and I.V. prescribing information. West Haven, CT; 2003 Mar.
10. Andriole VT. The future of the quinolones. Drugs. 1999; 58(Suppl 2): 1-5. [PubMed 10553697]
11. DeAbate CA, McIvor RA, Di Bartolo C et al. Gatifloxacin vs. cefuroxime axetil in patients with acute exacerbations of chronic bronchitis. J Respir Dis. 1999; 20(Suppl 11A):23-9.
12. Fogarty C, McAdoo M, Paster RZ et al. Gatifloxacin vs. clarithromycin in the management of acute sinusitis. J Respir Dis. 1999; 20(Suppl 11A):17-22.
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