Gatifloxacin
Gatifloxacin
Brand names:Zymar, Zymaxid
A fluoroquinolone antibiotic withdrawn from the systemic US market in 2006 due to dysglycemia events (hypoglycemia and hyperglycemia). Gatifloxacin remains available as an ophthalmic preparation for bacterial conjunctivitis. The drug appears in some legacy TCCC references but should not be used systemically. This entry documents the agent for historical context and to clarify current status.
Pharmacology and Actions
Gatifloxacin inhibits bacterial DNA gyrase and topoisomerase IV, blocking DNA replication. The mechanism is shared across the fluoroquinolone class. Gatifloxacin had broad activity against gram-positive, gram-negative, and atypical pathogens, similar to moxifloxacin. The drug was specifically associated with severe dysglycemia events that led to systemic withdrawal.
Indications
- Bacterial conjunctivitis (ophthalmic preparation only, current FDA-approved use)
- Historical TCCC reference for oral wound prophylaxis (no longer recommended)
Absolute Contraindications
- Systemic use in the United States (withdrawn from market)
- Known fluoroquinolone allergy
- Diabetes mellitus or any glucose dysregulation (historical contraindication)
- Pregnancy and breastfeeding for any remaining systemic use
- Pediatric patients under 18 years
Precautions and Side Effects
Severe dysglycemia (both hypoglycemia and hyperglycemia) was the adverse effect that led to systemic withdrawal in 2006. The mechanism appears to involve direct effects on pancreatic beta cells. Other fluoroquinolone class effects also apply: tendinopathy, QT prolongation, peripheral neuropathy, and CNS effects. The ophthalmic preparation has minimal systemic absorption and is not associated with dysglycemia at standard dosing.
Adult Dosing
Pediatric Dosing
Ophthalmic dosing applies to pediatric patients 1 year and older. Systemic gatifloxacin is contraindicated in pediatric patients.
Pharmacokinetics
Peak Effect: Ophthalmic: localized effect at administration site
Duration: Ophthalmic: dose every 2 hours initially; 4 times daily maintenance
Storage and Handling
Ophthalmic solution: store at controlled room temperature (15 to 25 degrees Celsius). Protect from light. Discard 28 days after opening to reduce contamination risk.
Reconstitution:
Ophthalmic solution is supplied ready to use. No reconstitution required.
TCCC and TECC Role
Gatifloxacin appears in legacy TCCC references from the early 2000s as an oral wound prophylaxis option. Following the 2006 systemic market withdrawal, gatifloxacin is no longer a viable TCCC systemic antibiotic. Current TCCC oral wound prophylaxis uses cefadroxil (primary) or cephalexin (alternative). Gatifloxacin remains useful only as an ophthalmic agent for bacterial conjunctivitis, which may be encountered in deployment and prolonged field care settings.
Gatifloxacin is the drug providers may encounter referenced in older TCCC materials but should not see in current systemic use in US tactical kits. If a kit contains oral or IV gatifloxacin, it is expired stock and should not be used systemically. The ophthalmic preparation is a legitimate current agent for bacterial conjunctivitis, which is a real consideration in austere environments where eye infections can degrade mission capability.
Using older TCCC reference materials without checking the current 2026 guidelines. Gatifloxacin systemic use ended in the US in 2006. Any provider working from older curricula or older kits needs to update to current cephalosporin-based wound prophylaxis (cefadroxil or cephalexin oral; ceftriaxone parenteral).
This drug profile is provided as educational reference material for trained medical providers. It is not medical advice, not a substitute for formal training, and not a substitute for current published guidelines or medical direction.
Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances are subject to additional handling, accountability, and documentation requirements per DEA and state law. Always verify dosing, indications, contraindications, and route of administration against current published guidelines and your local protocols before administration.
If this content is being viewed during a medical emergency, call 911 immediately and follow the direction of your local emergency dispatch and medical control. Do not use this reference as a substitute for emergency medical services.
Drug information evolves. Last reviewed dates and source citations are provided for each entry. Confirm currency against the cited source before clinical use.
Penn Tactical Solutions publishes this reference for educational purposes. PTS does not provide medical direction and does not assume responsibility for clinical decisions made in the field. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Educational reference for trained medical providers. Not medical advice. Not a substitute for formal training, current published guidelines, or medical direction. Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances require additional storage, accountability, and documentation per DEA and state law.
In a medical emergency, call 911. This reference is not a substitute for emergency medical services.
Verify dosing, indications, and contraindications against current published guidelines and your local protocols before administration. Confirm content currency against the source citation. Penn Tactical Solutions does not provide medical direction. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Gatifloxacin
| IV/IO | Not available; withdrawn from systemic US market. |
| PO | Not available; withdrawn from systemic US market. |