Fluoroquinolone類抗生素 Treatment of mild to moderate community-acquired pneumonia, acute bacterial exacerbation of chronic bronchitis, acute bacterial rhinosinusitis, skin and skin structure infections, intra-abdominal infections, prophylaxis and treatment of plague
藥理
Antibiotic, Fluoroquinolone
A broad spectrum of antimicrobial activity including G(+) and G(-) organisms, Chlamydia spp, anaerobes, and Mycobacterium tuberculosis. It inhibits bacterial DNA topoisomerases required for bacterial DNA replication, transcription, repair, and recombination.
藥動學
1. Bioavailability: approximately 90%
2. Protein binding 50%
3. Metabolism: metabolized in liver via glucuronide and sulfate conjugation, 15~21% unchanged renal excretion, t1/2 9~16 hr
Chronic obstructive pulmonary disease, acute exacerbation: Note: Some experts reserve for patients who have risk factors for poor outcomes (eg, ≥65 years of age, FEV1 <50% predicted, frequent exacerbations, major comorbidities), but are at low risk of Pseudomonas infection.
400 mg once daily for 3 to 7 days Intra-abdominal infection, community-acquired in patients without risk factors for resistance or treatment failure:
400 mg once daily for 4 to 5 days following adequate source control; for diverticulitis or uncomplicated appendicitis managed without intervention, duration is 7 to 10 days Mycoplasma hominis and Ureaplasma extragenital infections:
400 mg once daily; for patients who are immunocompromised, some experts recommend combination therapy with doxycycline Plague (Yersinia pestis), treatment:
400 mg once daily for 7 to 14 days and at least until 2 days after patient has defervesced Pneumonia, community-acquired: Note: Avoid use in patients with risk factors for P. aeruginosa
400 mg once daily for a minimum of 5 days; for inpatients with severe pneumonia or risk factors for methicillin-resistant Staphylococcus aureus, use as part of an appropriate combination regimen Skin and soft tissue infections (for patients who cannot receive beta-lactams):
400 mg once daily
小兒調整劑量
In pediatric patients, fluoroquinolones are not routinely first-line therapy, but after assessment of risks and benefits, can be considered a reasonable alternative for situations where no safe and effective substitute is available
腎功能調整劑量
1. Altered kidney function: No dosage adjustment necessary
2. Hemodialysis, Peritoneal dialysis, CRRT: Poorly dialyzed; No supplemental dose or dosage adjustment necessary
肝功能調整劑量
No dosage adjustment necessary; however, use with caution in this patient population secondary to the risk of QT prolongation.