II. Indications
- Conditions
- Acute Skin and Soft Tissue Infections
- Second-Line Agent for refractory covered infections
- Should be reserved for resistant infections refractory to other agents
- Activity
- See Below
- Broad spectrum Antibiotic FDA approved in 2017 for acute Bacterial Skin Infections
- Increased Gram Positive coverage (including MRSA) over other Quinolones
- Broad Gram Positive Bacteria coverage (including otherwise Quinolone resistant organisms)
- Methicillin Resistant Staphylococcus Aureus (MRSA, as well as MSSA)
- Staphylococcus Haemolyticus
- Staphylococcus lugdunensis
- Streptococcus Pyogenes
- Streptococcus agalactiae
- Streptococcus Anginosus (as well as Streptococcus Intermedius and StreptococcusConstellatus)
- Enterococcus faecalis
- Gram Negative Bacteria
- Escherichia coli
- Enterobacter cloacae
- Klebsiella Pneumoniae
- Pseudomonas aeruginosa
III. Contraindications
- See Fluoroquinolone
- Fluoroquinolone Hypersensitivity
IV. Mechanism
- Inhibition of Bacterial enzymes (DNA Replication, transcription, repair, recombination)
- Bacterial Topoisomerase 4
- DNA gyrase (Topoisomerase 2)
V. Dosing
- Oral
- Delafloxacin 450 mg orally every 12 hours for 5-14 days
-
Parenteral
- Delafloxacin 300 mg IV over 60 minutes every 12 hours
- Decrease dose to 200 mg IV every 12 hours if GFR 15-30 ml/min
- Transition to oral dosing when able
- Renal
- Adjust IV dose for GFR 15-30 ml/min (see above)
- Avoid Delafloxacin for GFR <15 ml/min (End Stage Renal Disease)
VI. Pharmacokinetics
- Protein binding: 84%
- Oral Bioavailability: 84%
- Hepatic metabolism (Glucuronidation)
- Excreted in urine and stool, partially metabolized
- IV Half-Life: 3.7 hours after a single IV dose
- Oral Half-Life: 4 to 8 hours after multiple doses
VII. Adverse Effects
- See Fluoroquinolone
- Common
- Serious
- See Fluoroquinolone
- Fluoroquinolones have several serious warnings (e.g. tendon rupture, Neuropathy, Aortic Dissection)
- QT Prolongation has NOT been seen with Delafloxacin
VIII. Safety
-
Fluoroquinolones are generally avoided in pregnancy
- Cartilage damage risk
- Unknown Safety in Lactation
- However, Fluoroquinolones are associated with risk of pediatric Arthropathy
IX. Resources
- Delafloxacin (DailyMed)
X. References
- (2018) Med Lett Drugs Ther 60(1543): 49-51
- (2017) Presc Lett 24(11): 66
- LoVecchio (2021) Crit Dec Emerg Med 35(3): 24
- Smith and LoVecchio (2017) Crit Dec Emerg Med 31(11):24
Images: Related links to external sites (from Bing)
Related Studies
Concepts | Antibiotic (T195) , Organic Chemical (T109) |
English | Delafloxacin, 1-(6-Amino-3,5-Difluoropyridin-2-Yl)-8-Chloro-6-Fluoro-7-(3-Hydroxyazetidin-1-yl)-4-Oxo-1,4-Dihydroquinoline-3-Carboxylic Acid, DELAFLOXACIN |