Gram-positive: methicillin-susceptible Staphylococcus aureus (MSSA) (highest quinolone activity vs. MSSA), methicillin-resistant Staphylococcus aureus (MRSA), Streptococcus pneumoniae, Enterococcus faecalis, Listeria monocytogenes
Gram-negative: Enterobacteriaceae, H. influenzae, other Haemophilus spp., N. gonorrhoeae, N. meningitides, M. catarrhalis, Stenotrophomonas maltophilia
Atypicals: Legionella pneumophilia, Chlamydia pneumonia, Mycoplasma pneumoniae
Inhibition of topoisomerase (DNA gyrase) enzymes, which inhibits relaxation of supercoiled DNA and promotes breakage of double stranded DNA.
Fluoroquinolones produce both concentration-dependent (peak:MIC), and a combination of concentration and time-dependent killing (AUC:MIC).
320mg dose; Cmax: 1.6mg/ml; Volume of distribution: 4.18; Table 2
Gastrointestinal: nausea, upper GI discomfort
CNS: headache, insomnia, dizziness; hallucinations, depression, psychotic reactions (rare)
Renal: interstitial nephritis
Cardiovascular: QTC prolongation, torsades de pointes, arrhythmias
Skin: Rash (10% of patients with rash develop severe rash which may require discontinuation of therapy)
Chronic bronchitis: 320mg PO q24h x 5 days
Community-acquired pneumonia: 320mg PO q24h x 7 days
Efficacy and safety not established in patients less than 18 years of age
Renal failure: CrCl < 40mL/min: 160mg PO q24 hours
Hemodialysis: 160mg PO q24 hours
Peritoneal dialysis: 160mg PO q24 hours
Contraindications: Hypersensitivity to gemifloxacin, other fluoroquinolones, or to any of its components
Divalent cations: aluminum, magnesium zinc, iron, calcium, antacids, sucralfate – reduced bioavailability of quinolones (can cause therapeutic failure)
Category C: Risk unknown. Human studies inadequate.
Therapeutic: Culture and sensitivities, signs and symptoms of infection
Toxic: Urinalysis, BUN, SCr, AST and ALT, Physicial examination: encephalopathic changes