Difloxacin (INN), marketed under the trade name Dicural, is a second-generation, synthetic fluoroquinolone antibiotic used in veterinary medicine. It has broad-spectrum, concentration dependent, bactericidal activity; however, its efficacy is not as good as enrofloxacin or pradofloxacin.
Indications and Usage
In 1997, the United States Food and Drug Administration approved difloxacin hydrochloride tablets for use in canines. Unlike other fluoroquinolones difloxacin has not been approved by the FDA for use in cats. It is also contraindicated for use in food animals.
The recommended dosing is 5–10 mg/kg once daily. This is based on the linear pharmacokinetics exhibited by difloxacin over the 5–60 mg/kg range. So the maximum dose is well within the established safety range, but drug accumulation in tissues prompts a recommendation that the medication should not be used for periods longer than thirty days. If there is no noticeable improvement after five days, then the condition should be reevaluated and all therapy options reconsidered. Difloxacin is indicated for infections caused by susceptible microorganisms in the conditions listed below. Treatment of skin and soft tissue infections till 2–3 days after clinical signs have ceased, up to a maximum of thirty days. Treatment of urinary tract infections for at least ten consecutive days.
Microbiology
Difloxacin is a bactericidal, broad-spectrum antibiotic that has activity against Gram-negative bacteria and Gram-positive bacteria. It exerts its antibacterial effect by interfering with the bacterial enzyme DNA gyrase, which is needed for the maintenance and synthesis of bacterial DNA. The minimum inhibitory concentrations (MICs) of pathogens isolated in clinical field trials conducted in the United States between 1991 and 1993 were determined using National Committee for Clinical Laboratory Standards (NCCLS).
Mechanism of action
The primary mode of action of fluoroquinolones involves interaction with enzymes essential for major DNA functions such as replication, transcription and recombination. Difloxacin inhibits DNA gyrase (also known as Topoisomerase II), an enzyme required for negative super coiling during DNA replication Cell death can occur through the inability of bacteria to maintain the DNA super helical structure.
Pharmacokinetics
Difloxacin is rapidly and almost completely absorbed after oral administration, and approximately 50% is bound to circulating plasma proteins. It is metabolized primarily by the liver through glucuronidation and secreted in the bile. It can also be reabsorbed with the bile. This allows reentry into the blood stream and recirculation, a mechanism that can extend the half-life. The longer half-life allows for once daily dosing. In contrast to other fluoroquinolones, renal clearance accounts for only 5% of the removal of difloxacin from the canine system, which makes it an attractive choice for dogs with compromised renal function.
aTotal body clearance/F = Dose/AUC
bSteady state volume of distribution/F = Dose•AUMC/AUC2
cVolume of distribution (area)/F = Vdβ = (T1/2)(CL/F)/0.693
As mentioned above, Difloxacin is not FDA-approved for use in cats. This is because the major route of metabolism is through glucuronidation, an enzymatic pathway that cats lack. Therefore, administration to cats would likely result in toxicity.
Difloxacin is stored at room temperature in a cool, dry place.
Chemical and Drug Interactions
Difloxacin has been used concurrently with ectoparasiticides, antiepileptics, anesthetics, antihistamines, and topical anti-inflammatory drugs without adverse effects. It inhibits the metabolism of theophylline, caffeine, cyclosporine and warfarin. Azlocillin, cimetidine and probenecid increase blood levels of difloxacin. Compounds (i.e. sucralfate, antacids, multivitamins) containing di- and trivalent cations (i.e. iron, aluminum, calcium, magnesium and zinc) may substantially interfere with the absorption of quinolones from the intestinal tract resulting in decreased bioavailability. Therefore, the concurrent oral administration of quinolones with foods, supplements or other preparations containing any of these compounds should be avoided.
Adverse effects
Like other fluoroquinolones, difloxacin causes arthropathy in immature growing animals, particularly dogs. Otherwise, it is very well tolerated. The most common adverse effects are gastrointestinal effects such as vomiting, diarrhea and anorexia, even in overdose. Only supportive measures, and not additional treatment, are recommended for management of overdose or toxicity as the reactions are self-limiting.