General Information


  • Slow IV infusion over 60 minutes into large vein to reduce risk of irritation
  • PO administration with food (not dairy products) and separate from multivitamins by at least 2 hours


  • Vial can be diluted with NS, D5W, SWFI, or LR to final concentration max 2mg/mL


  • NS, D5W, or LR

Pseudomonal and other gram negative infections of urinary tract, bone/joint, abdomen and other sites

Also used in Anthrax treatment (refer to CDC website)

Tier 3 Protected Antimicrobial

  • Limited to use for the listed indications. For all other indications, the antimicrobial must be ordered by an ID physician or an ID consult placed.
  • Prospective audit with feedback with provided by ASP/Pharmacy and utilization/compliance reported quarterly.

AHS Use Criteria

  • Traveler’s diarrhea
  • Typhoid/paratyphoid if allergic to ceftriaxone
  • Community acquired pneumonia if allergic to ceftriaxone AND azithromycin AND doxycycline
  • Serious Legionella infection, allergic to azithromycin AND doxycycline
  • Transition to PO in a susceptible gram-negative infection
  • Allergy to all alternatives, last line option
  • Monitor QTc in patients with increased risk
  • CBC, renal and hepatic function during prolonged therapy
  • Altered mental status
  • Tendinopathy
  • Neuropathy
  • Disordered glucose regulation (especially in diabetic patients)
  • QTc prolongation
  • Dysglycemia
  • Tendinopathy and rupture
  • GI upset
  • Rash
  • Retinal detachment
  • CNS toxicity including confusion, psychosis
  • Weakness exacerbation in myasthenia gravis

CYP1A2 inhibitor - Multiple interactions possible.

QTc prolongation - Increased risk with other agents that prolong QTc.

Divalent & trivalent cations including Al, Ca, Fe, Mg (antacids, dairy products, iron supplements, some enteral feeds) - Decreased absorption

Cyclosporine - Increased levels of cyclosporine

Warfarin - Increased INR

Methadone - Lowered seizure threshold

Antimicrobial class: Fluoroquinolone

Pregnancy category: C

Average serum half life: 4 hours

Urine penetration: Therapeutic

Lung penetration: Therapeutic

CSF penetration: Moderate

Biliary penetration: Therapeutic

Bone penetration: Therapeutic, excellent distribution to bones but use in osteomyelitis involving a broken bone can delay healing

Empiric use not recommended. Use for culture sensitive pathogens.