delafloxacin
Sources réglementaires consultées
Indications approuvées
- Infections bactériennes aiguës de la peau et des structures cutanées et pneumonie bactérienne communautaire dues à des germes sensibles.
Contre-indications
Absolues
- Hypersensibilité à la délafloxacine ou à d’autres fluoroquinolones ; grossesse ; femme en âge de procréer sans contraception ; allaitement ; âge inférieur à 18 ans.
Mises en garde cliniques
- Il peut provoquer une tendinite ou une rupture tendineuse, une neuropathie périphérique et des effets du système nerveux central invalidants ou potentiellement irréversibles ; arrêter immédiatement dès les premiers symptômes. — DailyMed, set_id fb77637a-88d9-4aea-958f-e270030ce30d
- Il peut exacerber une myasthénie et provoquer une faiblesse respiratoire ; éviter chez les patients ayant cet antécédent. — DailyMed, set_id fb77637a-88d9-4aea-958f-e270030ce30d
- Mise en garde majeure · Il a été associé à un anévrisme ou une dissection aortique ; éviter chez les patients à haut risque sauf absence d’alternative et orienter en urgence en cas de douleur thoracique, abdominale ou dorsale soudaine. — DailyMed, set_id fb77637a-88d9-4aea-958f-e270030ce30d
- Mise en garde majeure · Il peut perturber la glycémie, y compris provoquer une hypoglycémie sévère ; surveiller la glycémie chez les personnes diabétiques et arrêter en cas d’anomalie importante. — DailyMed, set_id fb77637a-88d9-4aea-958f-e270030ce30d
- Mise en garde majeure · Une diarrhée et une colite à Clostridioides difficile peuvent survenir pendant ou après le traitement ; évaluer toute diarrhée importante et arrêter si le diagnostic est confirmé. — DailyMed, set_id fb77637a-88d9-4aea-958f-e270030ce30d
Interactions médicamenteuses
- SévèreAntiacides et suppléments contenant des cations multivalents
Mécanisme: L’aluminium, le magnésium, le calcium, le fer et le zinc forment des chélates et réduisent fortement l’absorption orale.
Recommandation: Espacer les prises selon l’intervalle propre au produit.
DailyMed, set_id fb77637a-88d9-4aea-958f-e270030ce30d
Effets indésirables
Communs (≥1%)
Nausées, diarrhée, céphalées et vertiges
Rares mais graves
Rupture tendineuse, neuropathie périphérique persistante, réaction neuropsychiatrique sévère, anaphylaxie et dissection aortique
Grossesse et allaitement
Elle est contre-indiquée pendant la grossesse et chez les femmes en âge de procréer sans contraception. Pendant l’allaitement, décider d’interrompre soit l’allaitement, soit le traitement selon le bénéfice maternel.
Bibliographie récente (PubMed)
Pneumonia, classified as a lower respiratory tract illness, affects different parts of the bronchial system as well as alveoli and can present with varying severities depending on co-morbidities and causative pathogens. It can be broadly classified using the setting in which it was acquired, namely the community or hospital setting, the former being more common and spreading through person-to-person droplet transmission. Community-acquired pneumonia (CAP) is currently the fourth leading cause of death worldwide, and its high mortality makes continual insight into the management of the condition worthwhile. This review explores the literature specifically for severe CAP (sCAP) and delves into the diagnosis, various modalities of treatment, and management of the condition. This condition can be defined as pneumonia requiring mechanical ventilation in the ICU and/or presenting with sepsis and organ failure due to pneumonia. The disease process is characterized by inflammation of the lung parenchyma, initiated by a combination of pathogens and lowered local defenses. Acute diagnosis of the condition is vital in reducing negative patient outcomes, namely through clinical presentation, blood/sputum cultures, imaging modalities such as computed tomography scan, and inflammatory markers, identifying common causative pathogens such as Streptococcus pneumoniae, rhinovirus, Legionella, and viral influenza. Pathogens such as Escherichia coli should also be investigated in patients with chronic obstructive pulmonary disease. The mainstay of treating sCAP includes rapid ICU admission once a diagnosis has been confirmed, initiating sepsis protocol, and treatment with combined empiric antibiotic regimens consisting of beta-lactams and macrolides. Corticosteroid use alongside antibiotics shows promise in reducing inflammation, but its use has to be judged on a case-by-case basis. New drugs such as omadacycline, delafloxacin, and zabofloxacin have shown valid evidence for the treatme
Antimicrobial resistance stands as one of the most urgent global health concerns in the twenty-first century, with projections suggesting that deaths related to drug-resistant infections could escalate to 10 million by 2050 if proactive measures are not implemented. In intensive care settings, managing infections caused by multidrug-resistant (MDR) Gram-negative bacteria is particularly challenging, posing a significant threat to public health and contributing substantially to both morbidity and mortality. There are numerous studies on the antibiotics responsible for resistance in Gram-negative bacteria, but comprehensive research on resistance mechanisms against new antibiotics is rare. Considering the possibility that antibiotics may no longer be effective in combating diseases, it is crucial to comprehend the problem of emerging resistance to newly developed antibiotics and to implement preventive measures to curb the spread of resistance. Mutations in porins and efflux pumps play a crucial role in antibiotic resistance by altering drug permeability and active efflux. Porin modifications reduce the influx of antibiotics, whereas overexpression of efflux pumps, particularly those in the resistance-nodulation-cell division (RND) family, actively expels antibiotics from bacterial cells, significantly lowering intracellular drug concentrations and leading to treatment failure.This review examines the mechanisms of action, resistance profiles, and pharmacokinetic/pharmacodynamic characteristics of newly developed antibiotics designed to combat infections caused by MDR and carbapenem-resistant Gram-negative pathogens. The antibiotics discussed include ceftazidime-avibactam, imipenem-relebactam, ceftolozane-tazobactam, meropenem-vaborbactam, aztreonam-avibactam, delafloxacin, temocillin, plazomicin, cefiderocol, and eravacycline.
Delafloxacin (BAXDELA® in the USA; Quofenix® in the EU) is an anionic fluoroquinolone antibacterial that is approved for the treatment of community-acquired pneumonia (CAP) and acute bacterial skin and skin structure infections in adults. Delafloxacin demonstrated in vitro activity against Gram-positive and Gram-negative pathogens, including drug-resistant isolates. In a phase III trial in adults with CAP, delafloxacin was noninferior to moxifloxacin when assessed against FDA- and EMA-defined primary endpoints, with both fluoroquinolones achieving high treatment success rates. A prespecified subgroup analysis suggested that delafloxacin may be more efficacious than moxifloxacin in patients with a history of asthma or chronic obstructive pulmonary disease (COPD). Delafloxacin was generally well tolerated in patients with CAP, with most treatment-emergent adverse events graded as mild or moderate in severity. Fluoroquinolone-associated adverse events of special interest occurred infrequently, with no events of QT prolongation or phototoxicity reported with delafloxacin. Delafloxacin is an effective and generally well-tolerated treatment that increases the number of available treatments for CAP and, although further research is required, may be a useful option for patients with CAP and comorbid asthma or COPD. Community-acquired pneumonia (CAP) can be caused by bacterial infection of the lungs, and is a common cause of infection-related deaths. As drug-resistant bacteria are becoming more common, new antibacterial drugs are needed. Delafloxacin (BAXDELA® in the USA; Quofenix® in the EU) is a fluoroquinolone antibacterial that inhibits bacterial enzymes required for DNA repair and replication. Delafloxacin kills a wide range of bacteria, including some drug-resistant variants. During a trial in adults with CAP, delafloxacin was as effective as moxifloxacin (also a fluoroquinolone antibacterial). Delafloxacin may be more effective than moxifloxacin in patients with a his
This review discusses small molecule antibiotics approved for clinical use in the time frame 2010-2022. This time span saw the approval of four synthetic antibiotics (bedaquiline, pretomanid, delafloxacin, tedizolid), nine natural product derivatives (ceftaroline fosamil, cefiderocol, plazomicin, omadacycline, eravacycline, sarecycline, lefamulin, dalbavancin, oritavancin), and one natural product (fidaxomicin).