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Fluoroquinolones:
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Ciprofloxacin (Cipro ®)
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Mechanism of Action Inhibits DNA-gyrase in susceptible organisms; inhibits relaxation of supercoiled DNA and promotes breakage of double-stranded DNA Dosing (Adults): Note: Extended release tablets and immediate release formulations are not interchangeable. Unless otherwise specified, oral dosing reflects the use of immediate release formulations. ============================ Oral: ============================ Urinary tract infection: Acute uncomplicated: Immediate release formulation: 100 mg or 250 mg every 12 hours for 3 days Acute uncomplicated pyelonephritis: Extended release formulation: 1000 mg every 24 hours for 7-14 days Uncomplicated/acute cystitis: Extended release formulation: 500 mg every 24 hours for 3 days Mild/moderate: Immediate release formulation: 250 mg every 12 hours for 7-14 days Severe/complicated: Immediate release formulation: 500 mg every 12 hours for 7-14 days Extended release formulation: 1000 mg every 24 hours for 7-14 days Lower respiratory tract, skin/skin structure infections: 500-750 mg twice daily for 7-14 days depending on severity and susceptibility Bone/joint infections: 500-750 mg twice daily for 4-6 weeks, depending on severity and susceptibility Infectious diarrhea: 500 mg every 12 hours for 5-7 days Intra-abdominal (in combination with metronidazole): 500 mg every 12 hours for 7-14 days Typhoid fever: 500 mg every 12 hours for 10 days Urethral/cervical gonococcal infections: 250-500 mg as a single dose (CDC recommends concomitant doxycycline or azithromycin due to developing resistance; avoid use in Asian or Western Pacific travelers) Disseminated gonococcal infection (CDC guidelines): 500 mg twice daily to complete 7 days of therapy (initial treatment with ceftriaxone 1 g I.M./I.V. daily for 24-48 hours after improvement begins) Chancroid (CDC guidelines): 500 mg twice daily for 3 days Sinusitis (acute): 500 mg every 12 hours for 10 days Chronic bacterial prostatitis: 500 mg every 12 hours for 28 days Anthrax: Inhalational (postexposure prophylaxis): 500 mg every 12 hours for 60 days Cutaneous (treatment, CDC guidelines): Immediate release formulation: 500 mg every 12 hours for 60 days. Note: In the presence of systemic involvement, extensive edema, lesions on head/neck, refer to I.V. dosing for treatment of inhalational/gastrointestinal/oropharyngeal anthrax ============================ Adults: I.V.: ============================ Bone/joint infections: Mild to moderate: 400 mg every 12 hours for 4-6 weeks Severe or complicated: 400 mg every 8 hours for 4-6 weeks Lower respiratory tract, skin/skin structure infections: Mild to moderate: 400 mg every 12 hours for 7-14 days Severe or complicated: 400 mg every 8 hours for 7-14 days Nosocomial pneumonia (mild to moderate to severe): 400 mg every 8 hours for 10-14 days Prostatitis (chronic, bacterial): 400 mg every 12 hours for 28 days Sinusitis (acute): 400 mg every 12 hours for 10 days Urinary tract infection: Mild to moderate: 200 mg every 12 hours for 7-14 days Severe or complicated: 400 mg every 12 hours for 7-14 days Febrile neutropenia (with piperacillin): 400 mg every 8 hours for 7-14 days Intra-abdominal infection (with metronidazole): 400 mg every 12 hours for 7-14 days Anthrax: Inhalational (postexposure prophylaxis): 400 mg every 12 hours for 60 days Inhalational/gastrointestinal/oropharyngeal (treatment, CDC guidelines): 400 mg every 12 hours. Note: Initial treatment should include two or more agents predicted to be effective (per CDC recommendations). Agents suggested for use in conjunction with ciprofloxacin or doxycycline include rifampin, vancomycin, imipenem, penicillin, ampicillin, chloramphenicol, clindamycin, and clarithromycin. May switch to oral antimicrobial therapy when clinically appropriate. Continue combined therapy for 60 days. Elderly: No adjustment needed in patients with normal renal function ============================ Renal Dosing: [CRCL >30 ]: no changes . [5-30 ]: (IV): 200-400mg q18-24h or give 200mg q12h. (Oral): 250 q12h or, 250-500mg q18 to 24 hours. Hemodialysis: (IV): 200-400mg q24h or 200mg q12h. Schedule dose after dialysis on dialysis days. (Oral): 250mg q12h or 250-500mg q24h. Schedule dose after dialysis on dialysis days. ============================ SUPPLIED Infusion, [premixed in D5W] (Cipro®): 200 mg (100 mL); 400 mg (200 mL) [latex free] Injection, solution (Cipro®): 10 mg/mL (20 mL, 40 mL, 120 mL) Microcapsules for oral suspension (Cipro®): 250 mg/5 mL (100 mL); 500 mg/5 mL (100 mL) [strawberry flavor] Tablet [film coated]: 250 mg, 500 mg, 750 mg Cipro®: 100 mg, 250 mg, 500 mg, 750 mg Tablet, extended release [film coated] (Cipro® XR): 500 mg [equivalent to ciprofloxacin hydrochloride 287.5 mg and ciprofloxacin base 212.6 mg]; 1000 mg [equivalent to ciprofloxacin hydrochloride 574.9 mg and ciprofloxacin base 425.2 mg] |
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Gatifloxacin (Tequin ®)
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Dosing: 400 mg po/IV qd Renal Dosing: [CRCL >40]: No changes. [<40 ]: 400mg x 1, then 200mg qd. Hemodialysis: 400 mg x 1, then 200mg qd. (On dialysis days, schedule dose after dialysis.). PD: 400 mg x 1, then 200mg qd |
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Levofloxacin (Levaquin ®)
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INDICATIONS: Treatment of mild,
moderate, or severe infections caused by susceptible organisms. Includes
the treatment of community-acquired pneumonia, including multidrug
resistant strains of S. pneumoniae (MDRSP); nosocomial pneumonia;
chronic bronchitis (acute bacterial exacerbation); acute maxillary
sinusitis; urinary tract infection (uncomplicated or complicated),
including acute pyelonephritis caused by E. coli ; prostatitis (chronic
bacterial); skin or skin structure infections (uncomplicated or
complicated); prevention of inhalational anthrax (postexposure) Mechanism of Action As the S (-) enantiomer of the fluoroquinolone, ofloxacin, levofloxacin, inhibits DNA-gyrase in susceptible organisms thereby inhibits relaxation of supercoiled DNA and promotes breakage of DNA strands. DNA gyrase (topoisomerase II), is an essential bacterial enzyme that maintains the superhelical structure of DNA and is required for DNA replication and transcription, DNA repair, recombination, and transposition. ============================ Dosing (Adults): Oral, I.V.: Note: Sequential therapy (intravenous to oral) may be instituted based on prescriber's discretion. Chronic bronchitis (acute bacterial exacerbation): 500 mg every 24 hours for at least 7 days Inhalational anthrax: 500 mg every 24 hours for 60 days, beginning as soon as possible after exposure Maxillary sinusitis (acute): 500 mg every 24 hours for 10-14 days Pneumonia: Community-acquired: 500 mg every 24 hours for 7-14 days or 750 mg every 24 hours for 5 days (efficacy of 5-day regimen for MDRSP not established) Nosocomial: 750 mg every 24 hours for 7-14 days Prostatitis (chronic bacterial): 500 mg every 24 hours for 28 days Skin infections: Uncomplicated: 500 mg every 24 hours for 7-10 days Complicated: 750 mg every 24 hours for 7-14 days Urinary tract infections: Uncomplicated: 250 mg once daily for 3 days Complicated, including acute pyelonephritis: 250 mg every 24 hours for 10 days ============================ Renal Dosing: [CRCL >50] No change. [20-49]: 500 x 1, then 250mg q24h. Complicated skin/structure: 750 mg x 1, then 750mg q48h. [10-19]: 500mg x 1, 250mg q48h. Complicated skin/structure: 750 mg x 1, then 500mg q48h. [<10] same as above. Hemodialysis or PD: 500mg x 1, 250mg q48h. Complicated skin/structure: 750 mg x 1, then 500mg q48h. On dialysis days, schedule dose after dialysis. ============================ Administration Oral: Tablets may be administered without regard to meals. Oral solution should be administered 1 hour before or 2 hours after meals. I.V.: Infuse 250-500 mg I.V. solution over 60 minutes; infuse 750 mg I.V. solution over 90 minutes. Too rapid of infusion can lead to hypotension. Avoid administration through an intravenous line with a solution containing multivalent cations (eg, magnesium, calcium). ============================ SUPPLIED: Infusion [premixed in D5W] (Levaquin®): 250 mg (50 mL); 500 mg (100 mL); 750 mg (150 mL) Injection, solution [preservative free] (Levaquin®): 25 mg/mL (20 mL, 30 mL) Solution, oral (Levaquin®): 25 mg/mL (480 mL) [contains benzyl alcohol] Tablet (Levaquin®): 250 mg, 500 mg, 750 mg Levaquin® Leva-Pak: 750 mg (5s) |
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Moxifloxacin (Avelox ®)
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INDICATIONS -Treatment of
mild-to-moderate community-acquired pneumonia, including
multidrug-resistant Streptococcus pneumoniae (MDRSP); acute bacterial
exacerbation of chronic bronchitis; acute bacterial sinusitis;
uncomplicated skin infectionS. Dosing (Adults): 400 mg orally or IV q24h. Acute bacterial sinusitis: Oral, I.V.: 400 mg every 24 hours for 10 days. Chronic bronchitis, acute bacterial exacerbation: Oral, I.V.: 400 mg every 24 hours for 5 days. Note: Avelox® ABC Pack™ (Avelox® Bronchitis Course) contains five tablets of 400 mg each. Intra-abdominal infections, complicated: Oral, I.V.: 400 mg every 24 hours for 5-14 days (initiate with I.V.). Legionella(unlabeled use): Oral, I.V.: 400 mg every 24 hours for 10-21 days. Pneumonia, community-acquired (including MDRSP): Oral, I.V.: 400 mg every 24 hours for 7-14 days. Skin and skin structure infections: Oral, I.V.: Complicated: 400 mg every 24 hours for 7-21 days Uncomplicated: 400 mg every 24 hours for 7 days Renal Dosing: No adjustment necessary. Hemo: No specific guidelines available. Supplied: Tablet: 400mg. Avelox® ABC Pack: contains 5 unit dose 400mg tablets. IV (premixed): 400mg/250 ml NS. Ophthalmic soln ( Vigamox ®): 0.5% (3 ml). "RESPIRATORY QUINOLONE" Similar to other new-generation fluoroquinolones, such as grepafloxacin, levofloxacin, and trovafloxacin, moxifloxacin exhibits improved activity against pneumococci (S. pneumoniae) and other clinically relevant respiratory pathogens (eg, Haemophilus influenzae, Chlamydia, Mycoplasma), suggesting that it has a role in the treatment of ambulatory community-acquired pneumonia, sinusitis, and acute exacerbations of chronic bronchitis, particularly in older patients with underlying disease and those with resistance to other agents. Until direct comparative data are available, selection of one of these drugs over the other will be guided by mainly by cost. The overall in vitro activity of moxifloxacin is similar to that of trovafloxacin (Woodcock et al, 1997); (Barman et al, 1999). Compared to ciprofloxacin, moxifloxacin is more active against gram-positive organisms and anaerobes, but less active against the Enterobacteriaceae and Pseudomonas spp. Dave's Note: Not indicated for tx of UTI. |
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Norfloxacin (Noroxin ®)
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INDICATIONS Uncomplicated urinary
tract infections and cystitis caused by susceptible gram-negative and
gram-positive bacteria; sexually-transmitted disease (eg, uncomplicated
urethral and cervical gonorrhea) caused by N. gonorrhoeae ; prostatitis
due to E. coli Mechanism of Action Norfloxacin is a DNA gyrase inhibitor. DNA gyrase is an essential bacterial enzyme that maintains the superhelical structure of DNA. DNA gyrase is required for DNA replication and transcription, DNA repair, recombination, and transposition; bactericidal Oral: Adults: Urinary tract infections: 400 mg twice daily for 3-21 days depending on severity of infection or organism sensitivity; maximum: 800 mg/day Uncomplicated gonorrhea: 800 mg as a single dose (CDC recommends as an alternative regimen to ciprofloxacin or ofloxacin) Prostatitis: 400 mg every 12 hours for 4 weeks Dosing interval in renal impairment: Clcr 10-30 mL/minute: Urinary tract infections: Administer 400 mg every 24 hours Supplied Tablet: 400 mg |
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Ofloxacin (Floxin ®)
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Dosing (Adults):
200-400 mg po or IV q12h. Renal Dosing: [> 50 ml/min]: no changes. [20-50]: 200-400mg q24h. [<20]: 100-200mg q24h (1/2 of usual dose q24h.). Hemodialysis: Manufacturer states: For CRCL <20 ml/min give 50% of usual dose q24h. No specific info for hemodialysis. |
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