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Pharmacotherapy. 2018 Jan;38(1):108-121. doi: 10.1002/phar.2050. Epub 2017 Nov 23.

What Is Old Is New Again: Delafloxacin, a Modern Fluoroquinolone.

Author information

1
College of Pharmacy, The University of Texas at Tyler, Tyler, Texas.
2
Department of Pharmacy, Methodist Dallas Medical Center, Dallas, Texas.
3
Department of Pharmacy, OU Medical Center, Oklahoma City, Oklahoma.
4
College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida.

Abstract

Delafloxacin is a new fluoroquinolone antimicrobial approved for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) in adults using dosage regimens of 300 mg intravenously every 12 hours, 450 mg orally every 12 hours, or switching from intravenous to oral regimens for a 5- to 14-day treatment duration. Dosage adjustments in patients with severe renal dysfunction (estimated glomerular filtration rate [eGFR] = 15-29 ml/min/1.73 m2 ) are not required for oral doses but should be decreased to 200 mg intravenously every 12 hours in patients requiring parenteral therapy. Due to insufficient data, use of delafloxacin is not recommended for patients on hemodialysis or with end-stage renal disease (eGFR < 15 ml/min/1.73 m2 ). Delafloxacin works through inhibition of DNA gyrase (topoisomerase II) and topoisomerase IV, which are essential enzymes for bacterial DNA transcription, replication, repair, and recombination and exhibits bactericidal activity against gram-positive and gram-negative organisms through a concentration-dependent matter. Delafloxacin has a very broad spectrum of activity against atypical, anaerobic, and resistant gram-negative and gram-positive bacteria, including methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa. During phase 3 trials, the most common side effects associated with delafloxacin were gastrointestinal (nausea, diarrhea). Unlike other fluoroquinolones, there does not seem to be a risk of QTc prolongation or phototoxicity with delafloxacin. The availability of both parenteral and oral formulations for delafloxacin distinguishes it from many of the currently available agents approved for ABSSSIs. Phase 3 studies for the treatment of respiratory infections are currently under way, and future results of these studies will further help delineate the role of delafloxacin.

KEYWORDS:

delafloxacin; fluoroquinolone; methicillin-resistant Staphylococcus aureus; skin infection

PMID:
29059465
DOI:
10.1002/phar.2050

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