Trovafloxacin (Trovan)
(Mercy Pharmacy Update, June 1998)
   Trovafloxacin is a new broad spectrum fluoroquinolone which has been added
to the Hospital Formulary. Like ciprofloxacin, it is highly active against
gram-negative respiratory pathogens H. influenzae and M. catarrhalis and the
enteric gram-negatives such as E. coli, Klebsiella, and Enterobacter. In vitro
studies comparing the activity of trovafloxacin and ciprofloxacin against
Pseudomonas aeruginow have provided varying results. Some studies show it to
be less active or equivalent to ciprofloxacin, while others demonstrate
superior activity. The Mercy Hospital Microbiology Laboratory is presently
conducting a comparative susceptibility study to determine which agent is most
active against Pseudomonas isolates. Trovafloxacin has very good activity .
methicillin susceptible staphylococci and streptococci, including penicillin
resistant Strep pneumoniae and it has moderate activity against the
enterococci. The agents causing atypical pneumonia, Legionella, Mycoplasma,
and Chlamydia pneumoniae are very susceptible to trovafloxacin. It also has
good activity against anaerobic bacteria and is approved for the treatment of
infections caused by these organisms.
   Trovafloxacin is available both IV and PO and its long half-life allows for
once daily dosing. The oral absorption of trovafloxacin is 90% but may be
reduced 40-70% by concomitant administration of aluminum, sucralfate,
magnesium, iron and IV morphine, and reduced by 17% by omeprazole and
calcium. These agents should be avoided if possible, or the doses should be
separated by at least 2 hours.
   The usual dose of trovafloxacin for serious cases of nosocomial pneumonia,
intraabdominal and gynecologic infections is 300 mg IV Q 24 hours, followed by
200 ing PO Q 24 hours. No dosage adjustment is necessary with decreased renal
function but patients with cirrhosis may require a dose reduction.
   Dizziness and/or lightheadedness is the most common side offect. It is
generally mild, lasts for a few hours and often resolves with continued
dosing. Dizziness may be substantially reduced by taking the drug with food or
at bedtime.
   The following are indications for use of trovafloxacin at Mercy
Hospital:
 - Hospitalized community acquired pneumonia in patients at risk for
   enteric gram-negatives or PRSP
 - Intradodominal infections
 - Skin and skin structure infections, including diabetic foot infections
   without underlying osteomyelitis (nafcillin or cefazolin
   are the preferred drugs for MSSA and streptococcal infections)
Pertinent Information:
 - Serious Ps. aeruginosa Infections should be treated with combination
   therapy e.g. piperacillin or ceftazidime plus an aminoglycoside or a
   fluoroquinolone in patients with significant renal impairment.
 - Other agents should be used for UTI's, ostoomyelitis, surgical prophylaxis.
   IV and PO levels are the same, patients should be changed from IV to PO
   when oral intake is possible and the GI tract is functioning.
 - Monotherapy with trovafloxacin is less expensive than therapy with Unasyn,
   Zosyn, or Imipenem.
 - Trovafloxacin and ciprofloxacin use in the intensive care units should be
   limited to preserve the activity of these agents against resistant
   organisms e.g. Enterobacter and Ps. aeruginosa.