COMPANION HANDBOOK TO THE WHO GUIDELINES FOR THE PROGRAMMATIC MANAGEMENT OF DRUG-RESISTANT TUBERCULOSIS

Gatifloxacin (Gfx)
DRUG CLASS: FLUOROQUINOLONE

Activity against TB, Bactericidal; acts by inhibiting the A subunit of DNA gyrase
mechanism of action, (topoisomerase), which is essential in the reproduction of and
and metabolism metabolism bacterial DNA.

Dose 400 mg/day

Route of administration Oral.

Preparation Tablets, 200 or 400 mg.

Storage Room temperature (15–25 °C), airtight containers protected from

light.

Oral absorption Readily absorbed from the gastrointestinal tract with an absolute
bioavailability of 96%. Gatifloxacin in an anion and taking with
divalent cations will result in bonding and not being absorbed.
Administrate two hours before or four hours after ingestion of milk-
based products, antacids or other medications containing divalent
cations (iron, magnesium, calcium, zinc, vitamins, didanosine,
sucralfate).

CSF penetration Widely distributed in body fluids including CSF.

Special circumstances Pregnancy/breastfeeding: safety class C. Fluoroquinolones are

not recommended during breastfeeding due to the potential for
arthropathy. Animal data demonstrated arthropathy in immature
animals, with erosions in joint cartilage.
Renal disease: doses of gatifloxacin should be reduced in patients
with renal impairment. When creatinine clearance is less than
30 ml/min, the recommended dosing is 400 mg, 3 times per week.

Adverse reactions Generally well tolerated.

Occasional: gastrointestinal intolerance;
Rare CNS-headache; malaise; insomnia; restlessness; dizziness;
allergic reactions; diarrhoea; photosensitivity; increased liver
function tests; tendon rupture (increased incidence seen in older
men with concurrent use of corticosteroids).
Severe dysglycaemia, hypoglycaemia and hyperglycaemia, and
diabetes have been reported (many countries have removed the
drug form their national formularies for this reason).

Contraindications Pregnancy
Intolerance of fluoroquinolones
Diabetes. Gatifloxacin can worsen diabetes and glycaemic control.

Monitoring Glucose monitoring every 1–2 weeks.

270
 Anti-TB drug information sheets

Patient instructions Instruct patients to inform their health care provider right away if
and alerting symptoms any of the following occurs:
•Rashes, hives, bruising or blistering, trouble breathing
•Pain, swelling or tearing of a tendon or muscle or joint pain.
•Diarrhoea
•Yellow skin or eyes
•Anxiety, confusion or dizziness (signs of hypoglycaemia or
hyperglycaemia)
•Increased thirst or frequent urination (sign of hyperglycaemia)

271