GATIFLOXACIN

GATIFLOXACIN (gat-i-flox'a-sin) Zymer Classifications: antibiotic; quinolone; Therapeutic: antibiotic Prototype: Ciprofloxacin Pregnancy Category: C

Availability

200 mg, 400 mg tablets; 0.3% ophthalmic solution

Action

Synthetic quinolone that is a broad-spectrum bactericidal agent. Inhibits DNA-gyrase, topoisomerase II, an enzyme necessary for bacterial replication, transcription, repair, and recombination.

Therapeutic Effect

Effective against gram-positive and gram-negative bacteria.

Uses

Acute bacterial exacerbation of chronic bronchitis; acute sinusitis; community-acquired pneumonia; uncomplicated or complicated UTI; pyelonephritis; gonorrhea due to susceptible organisms.

Contraindications

Hypersensitivity to gatifloxacin or other quinolone antibiotics; diabetes mellitus; viral infections; pregnancy (category C); lactation. Safety and efficacy in children <18 y are unknown. Ophthalmic use in infants <1 mo.

Cautious Use

Patients with CNS disorders including seizures or epilepsy; myasthenia gravis; GI disorders, renal dysfunction; hypersensitivity to other medications; concurrent administration of aluminum-containing antacids.

Route & Dosage

Acute Bacterial Exacerbation of Chronic Bronchitis, Complicated Adult: PO 400 mg q.d. x 5 d Complicated UTI, Acute Pyelonephritis Adult: PO 400 mg q.d. x 7–10 d Acute Sinusitis Adult: PO 400 mg q.d. x 10 d Community-Acquired Pneumonia Adult: PO 400 mg q.d. x 7–14 d Uncomplicated UTI Adult: PO 400 mg as a single dose or 200 mg q.d. x 3 d Uncomplicated Gonorrhea Adult: PO 400 mg as a single dose Renal Impairment Clcr <40 mL/min or on dialysis: 400 mg x 1 d, then 200 mg q.d.

Administration

Oral

• Give at least 4 h before or after an aluminum- or magnesium-containing antacid, or iron-containing products.
• Store at 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

Body as a Whole: Headache, allergic reactions, chills, fever; back pain, chest pain. CNS: Dizziness, abnormal dreams, insomnia, paresthesia, tremor, vasodilatation, vertigo. CV: Palpitation; peripheral edema. GI: Nausea, diarrhea, abdominal pain, constipation, dyspepsia, glossitis, oral moniliasis, stomatitis, vomiting. Respiratory: Dyspnea, pharyngitis. Skin: Rash, sweating. Urogenital: Vaginitis, dysuria, hematuria. Special Senses: Abnormal vision, taste perversion, tinnitus. Metabolic: Hyperglycemia, hypoglycemia. Other: Cartilage erosion.

Diagnostic Test Interference

May cause false positive on opiate screening tests.

Interactions

Drug: Probenecid decreases elimination of gatifloxacin; ferrous sulfate, ALUMINUM- or MAGNESIUM-CONTAINING ANTACIDS reduce absorption of gatifloxacin; gatifloxacin may cause slight increase in digoxin levels.

Pharmacokinetics

Absorption: 96% from GI tract. Peak: 1–2 h PO. Distribution: 20% protein bound. Metabolism: Minimal metabolism (<1%). Elimination: Primarily in urine. Half-Life: 7–14 h (up to 35–40 h in severe renal failure).

Nursing Implications

Assessment & Drug Effects

• Monitor for S&S of CNS disturbance especially with history of cerebrovascular disease or seizures.
• Lab tests: C&S prior to initiation of therapy; WBC with differential.
• Monitor diabetics for loss of glycemic control.
• Monitor for changes in digoxin blood levels with coadministered drugs.

Patient & Family Education

• Be aware that increased risk of seizures are associated with drug use in patient with history of seizures.
• Report unexplained dizziness or problems with balance, tendon pain, severe diarrhea, skin rash, mental status changes.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug