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Pronunciation

FLUOROQUINOLONES: floor-oh-KWIN-oh-lones

ciprofloxacin : sip-roe-FLOX-a-sin

delafloxacin: del-a-FLOKS-a-sin

levofloxacin: le-voe-FLOX-a-sin

moxifloxacin : mox-i-FLOX-a-sin

ofloxacin : oh-FLOX-a-sin

Classifications

Therapeutic Classification: anti-infectives

Pharmacologic Classification: Fluoroquinolones

Indications

REMS


Action

  • Inhibit bacterial DNA synthesis by inhibiting DNA gyrase.
Therapeutic effects:
  • Death of susceptible bacteria.

Spectrum:

Pharmacokinetics

Absorption: Well absorbed after oral administration (ciprofloxacin: 70%; delafloxacin: 59%; moxifloxacin: 90%; levofloxacin: 99%; ofloxacin: 98%).

Distribution: Widely distributed. High tissue and urinary levels are achieved. Ciprofloxacin and ofloxacin enter breast milk.

Metabolism/Excretion: Ciprofloxacin: 15% metabolized by the liver, 40–50% excreted unchanged by the kidneys; delafloxacin: primarily undergoes glucuronidation; 50–65% excreted unchanged by the kidneys; 28–48% excreted unchanged in feces; levofloxacin: 87% excreted unchanged in urine, small amounts metabolized; moxifloxacin: mostly metabolized by the liver, 20% excreted unchanged in urine, 25% excreted unchanged in feces; ofloxacin: 70–80% excreted unchanged by the kidneys.

Half-Life: Ciprofloxacin: 4 hr; delafloxacin: 3.7 hr (IV); 4.2–8.5 hr (PO); levofloxacin: 8 hr; moxifloxacin: 12 hr; ofloxacin: 5–7 hr (all are in renal impairment).

Time/Action Profile

( blood levels)

ROUTEONSETPEAKDURATION
Ciprofloxacin: POrapid1–2 hr12 hr
Ciprofloxacin: IVrapidend of infusion12 hr
Delafloxacin: POrapid1 hr12 hr
Delafloxacin: IVrapidend of infusion12 hr
Levofloxacin: POrapid1–2 hr24 hr
Levofloxacin: IVrapidend of infusion24 hr
Moxifloxacin: POwithin 1 hr1–3 hr24 hr
Moxifloxacin: IVrapidend of infusion24 hr
Ofloxacin: POrapid1–2 hr12 hr
Ofloxacin: IVrapidend of infusion12 hr

Contraind./Precautions

Contraindicated in:

Use Cautiously in:

Adv. Reactions/Side Effects

CV: AORTIC ANEURYSM/DISSECTION, myocardial ischemia, QT interval prolongation (levofloxacin, moxifloxacin), TORSADES DE POINTES, vasodilation

Derm: ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS, photosensitivity, rash, STEVENS-JOHNSON SYNDROME (SJS)

Endo: hyperglycemia, hypoglycemia

GI: diarrhea, nausea, liver enzymes (ciprofloxacin, moxifloxacin), abdominal pain, CLOSTRIDIOIDES DIFFICILE-ASSOCIATED DIARRHEA (CDAD), HEPATOTOXICITY (CIPROFLOXACIN), vomiting

GU: vaginitis

Local: phlebitis

MS: arthralgia, myalgia, tendinitis, tendon rupture

Neuro: dizziness, headache, insomnia, INTRACRANIAL PRESSURE (INCLUDING PSEUDOTUMOR CEREBRI), acute psychoses, agitation, anxiety, attention disturbances, confusion, depression, drowsiness, hallucinations, light-headedness, memory impairment, nightmares, paranoia, peripheral neuropathy, SEIZURES, SUICIDAL THOUGHTS/BEHAVIORS, toxic psychosis, tremor

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions

Drug-drug:

Drug-Natural Products:

Drug-Food:

Route/Dosage

Ciprofloxacin

Renal Impairment

Delafloxacin

Renal Impairment

Levofloxacin

Renal Impairment

Moxifloxacin

Ofloxacin

Renal Impairment

Availability

Ciprofloxacin

(Generic available)

Delafloxacin

Levofloxacin

(Generic available)

Moxifloxacin

(Generic available)

Ofloxacin

(Generic available)

Assessment

Lab Test Considerations:

Implementation

Patient/Family Teaching

Evaluation/Desired Outcomes

US Brand Names

ciprofloxacin : Cipro, Cipro XR,

delafloxacin: Baxdela,

levofloxacin: Levaquin,

moxifloxacin : Avelox,

ofloxacin : Floxin