Chemistry:Gatifloxacin

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Gatifloxacin (brand names Gatiflo, Tequin, and Zymar) is an antibiotic of the fourth-generation fluoroquinolone family[1] that, like other members of that family, inhibits the bacterial enzymes DNA gyrase and topoisomerase IV.

It was patented in 1986 and approved for medical use in 1999.[2]

Side effects

A Canadian study published in the New England Journal of Medicine in March 2006, claimed that Tequin can have significant side effects including dysglycemia.[3] An editorial by Jerry Gurwitz in the same issue called for the Food and Drug Administration (FDA) to consider giving Tequin a black box warning.[4] This editorial followed distribution of a letter dated February 15 by Bristol-Myers Squibb to health care providers indicating action taken with the FDA to strengthen warnings for the medication.[5] Subsequently, Bristol-Myers Squibb reported it would stop manufacture of Tequin, end sales of the drug after existing stockpiles were exhausted, and return all rights to Kyorin.[6] Other reported, albeit rare, side effects included one report of rhabdomyolysis and a few reports of heart attacks in at-risk patients.[7][8]

By contrast, ophthalmic gatifloxacin is generally well tolerated. The observed systemic concentration of the drug, following oral administration, of 400 mg (0.01 ounces) gatifloxacin is approximately 800 times higher than that of the 0.5% gatifloxacin eye drop. Given as an eye drop, gatifloxacin has very low systemic exposure. Therefore, the systemic exposures resulting from the gatifloxacin ophthalmic solution are not likely to pose any risk for systemic toxicities.[9] Some patients have reported side effects akin to allergic reactions.[10]

Contraindications

Gatifloxacin is contraindicated in patients who are hypersensitive to gatifloxacin or other quinolones.[11]

Society and culture

Availability

Gatifloxacin is currently available in the US and Canada only as an ophthalmic solution.[12]

In 2011, the Union Health and Family Welfare Ministry of India banned the manufacture, sale, and distribution of gatifloxacin because of its adverse side effects.[13]

In many countries, such as China, gatifloxacin is also available as tablets and in various aqueous solutions for intravenous therapy.[14][15]

Brand names

Bristol-Myers Squibb introduced gatifloxacin in 1999 under the proprietary name Tequin for the treatment of respiratory tract infections, having licensed the medication from Kyorin Pharmaceutical Company of Japan.

References

  1. ↑ "The effect of fourth-generation fluoroquinolones gatifloxacin and moxifloxacin on epithelial healing following photorefractive keratectomy". American Journal of Ophthalmology 140 (1): 83–87. July 2005. doi:10.1016/j.ajo.2005.02.037. PMID 15953577. https://zenodo.org/record/1258684. 
  2. ↑ Analogue-based Drug Discovery. John Wiley & Sons. 2006. p. 501. ISBN 978-3-527-60749-5. https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA501. 
  3. ↑ "Outpatient gatifloxacin therapy and dysglycemia in older adults". The New England Journal of Medicine 354 (13): 1352–1361. March 2006. doi:10.1056/NEJMoa055191. PMID 16510739.  Note: publication date 30 March; available on-line 1 March
  4. ↑ "Serious adverse drug effects--seeing the trees through the forest". The New England Journal of Medicine 354 (13): 1413–1415. March 2006. doi:10.1056/NEJMe068051. PMID 16510740. https://escholarship.umassmed.edu/meyers_pp/54. 
  5. ↑ "Dear Healthcare Provider". Bristol-Myers Squibb. February 15, 2006. https://www.fda.gov/medwatch/safety/2006/tequin_DHCP.pdf. 
  6. ↑ "Drug Company Taking Tequin Off Market". Associated Press. May 1, 2006. http://www.sfgate.com/cgi-bin/article.cgi?file=/news/archive/2006/05/01/national/w120748D88.DTL&type=health. 
  7. ↑ "Risk assessment for antimicrobial agent-induced QTc interval prolongation and torsades de pointes". Pharmacotherapy 21 (3): 301–319. March 2001. doi:10.1592/phco.21.3.301.34206. PMID 11253855. 
  8. ↑ "Gatifloxacin-induced rhabdomyolysis". Journal of Postgraduate Medicine 54 (3): 233–234. 2008. doi:10.4103/0022-3859.41813. PMID 18626179. 
  9. ↑ "Gatifloxacin ophthalmic solution for treatment of bacterial conjunctivitis: safety, efficacy and patient perspective". Ophthalmology and Eye Diseases 4. 2012. doi:10.4137/OED.S7383. PMID 23650458. 
  10. ↑ "Gatifloxacin". Memorial Sloan Kettering Cancer Center. https://www.mskcc.org/cancer-care/patient-education/medications/adult/gatifloxacin. 
  11. ↑ "Gatifloxacin Ophthalmic: MedlinePlus Drug Information". https://medlineplus.gov/druginfo/meds/a605012.html. 
  12. ↑ "Gatifloxacin". Johns Hopkins ABX Guide. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540240/all/Gatifloxacin?refer=true. 
  13. ↑ "Two drugs banned". The Hindu (Chennai, India). 19 March 2011. http://www.thehindu.com/news/national/article1551233.ece. 
  14. ↑ "Gatifloxacin". https://pubchem.ncbi.nlm.nih.gov/compound/5379. 
  15. ↑ "Gatifloxacin Tablets". https://www.echemi.com/drugs/drug250516149140-gatifloxacin-tablets-01g-calculated-as-c19h22fn3o4-447.html. 



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