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delafloxacin

Brand: Baxdela

⚠ BBW Prototype: ciprofloxacin
Drug Class: fluoroquinolone antibiotic
Drug Family: antibiotic
Subclass: anionic fluoroquinolone with enhanced acidic environment activity
Organ Systems: infectious-diseaserespiratory

Mechanism of Action

Inhibits DNA gyrase and topoisomerase IV; unique anionic structure enhances activity in acidic environments (abscesses, infected tissues), including against MRSA. More potent against gram-positive organisms than other fluoroquinolones while retaining gram-negative activity.

DNA gyrase (topoisomerase II)topoisomerase IV

Indications

  • acute bacterial skin and skin structure infections (ABSSSI) including MRSA
  • community-acquired bacterial pneumonia (CABP)

Contraindications

  • fluoroquinolone hypersensitivity

Adverse Effects

Common

  • nausea
  • diarrhea
  • headache
  • elevated LFTs

Serious

  • tendinopathy/rupture
  • peripheral neuropathy
  • QTc prolongation (less than moxifloxacin)
  • C. difficile colitis
  • CNS effects

Pharmacokinetics (ADME)

Absorption oral or IV; oral bioavailability ~58%
Distribution large Vd; concentrated in tissues and acidic environments
Metabolism primarily by glucuronidation and renal excretion
Excretion renal (~50% IV) and fecal (~28%); dose adjustment for severe renal impairment
Half-life 3.7–8.5 hours
Onset rapid
Peak 0.75 hours (IV), 1 hour (oral)
Duration 12 hours
Protein Binding 84%
Vd large

Drug Interactions

Drug / Agent Mechanism Severity
antacids/sucralfate/iron/zinc chelation reduces oral absorption; separate by 2 hours moderate
QTc-prolonging drugs additive QTc prolongation; monitor ECG moderate

Nursing Considerations

  1. Available in both IV and oral formulations enabling step-down therapy; oral bioavailability is lower than levofloxacin, so IV initiation for serious infections is preferred.
  2. Counsel patients on all fluoroquinolone class black box warnings; particular emphasis on tendon rupture and peripheral neuropathy.
  3. Dose adjustment is required for patients with eGFR <15 mL/min for the IV formulation (contains SBECD cyclodextrin vehicle that accumulates).
  4. Monitor for C. difficile infection; delafloxacin has broad-spectrum activity that disrupts gut flora.

Clinical Pearls

  • Delafloxacin's anionic charge causes it to concentrate in acidic environments such as abscesses, where many antibiotics lose potency — an advantage for treating difficult-to-drain skin and soft tissue infections.
  • Delafloxacin has FDA approval specifically for ABSSSI due to MRSA, distinguishing it from other fluoroquinolones and reflecting its superior gram-positive activity.

Safety Profile

Pregnancy avoid
Lactation avoid
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required
Guideline Update pending

Concordance Terms

Cross-referenced clinical concepts — click any term to see all content where it appears.

Acute Bacterial Skin And Skin Structure Infections (ABSSSI) Including MRSA Community-acquired Bacterial Pneumonia (CABP) Fluoroquinolone Antibiotic
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