Trovafloxacin mesilate

Intravenous
Complicated intra-abdominal infections, Gynaecological infections, Nosocomial pneumonia, Pelvic infections

Oral
Community-acquired pneumonia, Complicated skin and skin structure infections

Child-Pugh Class A and B: Use 200 mg IV instead if the normal dose used is 300mg IV. Use 100 mg IV or oral instead if the normal dose used is 200mg IV or oral. Child-Pugh Class C: avoid.

May be taken with or without food.

Dilute with a suitable volume of diluent (e.g. 5% Dextrose Inj, 0.45% Sodium Chloride Inj, 5% Dextrose and 0.45% Sodium Chloride Inj, 5% Dextrose and 0.2% Sodium Chloride Inj, Lactated Ringer's and 5% Dextrose Inj) to a concentration of 1-2 mg/ml and run as a infusion over 60 min.

Do not dilute with 0.9% Sodium Chloride Inj or Lactated Ringer's.

Severe hepatic cirrhosis, hypersensitivity to quinolones. Adolescent<18 yr; lactation; pregnancy.

Impaired hepatic function; G6PD deficiency; history of CNS disorders e.g. severe cerebral atherosclerosis, epilepsy. Avoid exposure to strong sunlight/sunlamp. Discontinue in case of pain, inflammation or rupture of tendon. Discontinue if phototoxicity or skin rash occurs. May impair ability to drive and operate machinery. Decrease incidence of drowsiness by taking at bedtime or with food. Perform liver function and pancreatic tests when symptoms develop. Increased risk of hepatotoxicity when used > 2 wk. Avoid rapid or bolus inj. Oral doses to be admin at least 2 hr before or 2 hr after magnesium or aluminum containing antacids, sucralfate, citric acid buffered with sodium citrate, metal cations (e.g. ferrous sulfate) and didanosine. IV morphine to be admin at least 2 hr after oral trovafloxacin in the fasted state and at least 4 hr after oral trovafloacin is taken with food.

Dizziness, convulsions, increased intracranial pressure, CNS stimulation (e.g. tremor, restlessness, hallucinations), pseudomembranous colitis, phototoxicity, pancreatitis.
Potentially Fatal: Hapatotoxicity, anaphylactic reactions, severe hypotension, Stevens-Johnson syndrome.

PO: C

Symptoms: decreased activity and respiration, ataxia, ptosis, tremors and convulsions. Management: Empty stomach by inducing vomiting or by gastric lavage. Treatment is symptomatic and supportive with close monitoring. Maintain adequate hydration. Haemodialysis unlikely to be useful.

Decreased oral absorption with antacids containing aluminum and magnesium salts, citric acid/sodium citrate, strontium, sucralfate, vitamins or minerals containing iron or zinc and concomitant admin of IV morphine. Increased risk of convulsions with NSAIDs. Increased anticoagulant effect with acenocoumarol, warfarin.
Potentially Fatal: Increased risk of severe hypotension with general anaesthetic agents.

Description: Trovafloxacin has actions and uses similar to those of ciprofloxacin, but is more active against pneumococci. It is available as trovafloxacin mesilate for oral admin and as alatrofloxacin mesilate inj (a prodrug of trovafloxacin) for IV admin. Due to reported incidences of hepatotoxicity, trovafloxacin should be used only in serious, life- or limb-threatening infections caused by susceptible strains.
Pharmacokinetics:
Absorption: Readily absorbed from GI tract. Peak plasma concentration: 1-2 hr. Oral bioavailability: 88%.
Distribution: Widely distributed and found in breast milk. Protein binding: 76%.
Metabolism: Metabolised by conjugation. Half-life: 9-12 hr. After IV inj, alatrofloxacin, the prodrug of trovofloxacin, is rapidly converted to trovafloxacin.
Excretion: Excreted in urine and faeces as metabolites and unchanged drug.

Tab: Store at 15-30°C (59-86°F). Inj: Store at 15-30°C (59-86°F); protect from light; do not freeze.

Quinolones