delafloxacin

Delafloxacin is a fluoroquinolone antibiotic marketed under the brand name Baxdela. It is available in both oral and intravenous formulations for clinical use.

Delafloxacin inhibits bacterial DNA synthesis by targeting two essential enzymes, DNA gyrase (topoisomerase II) and topoisomerase IV, yielding bactericidal activity. It demonstrates activity against a range of Gram-positive organisms, including methicillin-resistant Staphylococcus aureus (MRSA), and many Gram-negative pathogens. The drug is noted for maintaining activity in acidic environments, which can be relevant to skin and soft tissue infections.

Indications and administration: In the United States, delafloxacin is approved for the treatment of acute bacterial skin and skin structure infections (ABSSSI). The availability of both intravenous and oral forms supports initiating therapy intravenously and stepping down to oral dosing when appropriate, according to clinical judgment and guidelines.

Safety and adverse effects: As a fluoroquinolone, delafloxacin carries class warnings for tendinopathy and tendon rupture, peripheral neuropathy, central nervous system effects, QT interval prolongation, and hypoglycemia or hyperglycemia. Common adverse events include nausea, diarrhea, rash, and elevated liver enzymes. It is generally avoided in pregnancy and in children; caution is advised in older adults and in patients with risk factors for QT prolongation or renal impairment. Principles of antibiotic stewardship apply to its use to limit resistance development.

History and status: Delafloxacin received U.S. FDA approval in 2017 for ABSSSI and has since been marketed as Baxdela by Melinta Therapeutics. Further indications have been explored in clinical development and literature, but ABSSSI remains the primary approved indication in many regions.