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{{drugbox
{{Drugbox
| IUPAC_name = 5-amino-1-cyclopropyl-7-[(3''R'',5''S'')3,5-dimethylpiperazin-<br>1-yl]-6,8-difluoro-4-oxo-quinoline-3-carboxylic acid
| Watchedfields = changed
| image = Sparfloxacin.svg
| verifiedrevid = 464405887
| IUPAC_name = 5-Amino-1-cyclopropyl-7-[(3''R'',5''S'')3,5-dimethylpiperazin-1-yl]-6,8-difluoro-4-oxo-quinoline-3-carboxylic acid
| image = Sparfloxacin Wiki Str.png
 
<!--Clinical data-->
| tradename = 
| Drugs.com = {{drugs.com|CONS|sparfloxacin}}
| MedlinePlus = a600002
| pregnancy_US = C
| legal_US = Rx-only
| routes_of_administration = Oral
 
<!--Pharmacokinetic data-->
| bioavailability = 92%
| protein_bound = 45%
| metabolism = [[Liver|Hepatic]] [[glucuronidation]]<br> [[Cytochrome P450 oxidase|Cytochrome P450]] system not involved
| elimination_half-life = 16 to 30 hours
| excretion = Fecal (50%) and [[Kidney|renal]] (50%)
 
<!--Identifiers-->
| CASNo_Ref = {{cascite|correct|CAS}}
| CAS_number_Ref = {{cascite|correct|??}}
| CAS_number = 110871-86-8
| CAS_number = 110871-86-8
| ATC_prefix = J01
| ATC_prefix = J01
| ATC_suffix = MA09
| ATC_suffix = MA09
| ATC_supplemental =
| PubChem = 60464
| PubChem = 60464
| DrugBank = APRD01231
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| C = 19 | H = 22 | F = 2 | N = 4 | O = 3
| DrugBank = DB01208
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID = 54517
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = Q90AGA787L
| KEGG_Ref = {{keggcite|correct|kegg}}
| KEGG = D00590
| ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEBI = 9212
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL = 850
 
<!--Chemical data-->
| C=19 | H=22 | F=2 | N=4 | O=3  
| molecular_weight = 392.41 g/mol
| molecular_weight = 392.41 g/mol
| bioavailability = 92%
| smiles = C[C@@H]1CN(C[C@@H](N1)C)c2c(c(c3c(c2F)n(cc(c3=O)C(=O)O)C4CC4)N)F
| protein_bound = 45%
| InChI = 1/C19H22F2N4O3/c1-8-5-24(6-9(2)23-8)17-13(20)15(22)12-16(14(17)21)25(10-3-4-10)7-11(18(12)26)19(27)28/h7-10,23H,3-6,22H2,1-2H3,(H,27,28)/t8-,9+
| metabolism = [[Liver|Hepatic]] [[glucuronidation]]<br> [[Cytochrome P450 oxidase|Cytochrome P450]] system not involved
| InChIKey = DZZWHBIBMUVIIW-DTORHVGOBM
| elimination_half-life = 16 to 30 hours
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| excretion = Fecal (50%) and [[Kidney|renal]] (50%)
| StdInChI = 1S/C19H22F2N4O3/c1-8-5-24(6-9(2)23-8)17-13(20)15(22)12-16(14(17)21)25(10-3-4-10)7-11(18(12)26)19(27)28/h7-10,23H,3-6,22H2,1-2H3,(H,27,28)/t8-,9+
| pregnancy_US = C
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| legal_US = Rx-only
| StdInChIKey = DZZWHBIBMUVIIW-DTORHVGOSA-N
| routes_of_administration = Oral
}}
}}
__NOTOC__
{{SI}}
{{SI}}
{{CMG}}
== Overview ==


'''Sparfloxacin''' (spar FLOX a sin), trade names '''Spacin''' in Bangladesh, '''Zagam''' and '''Zagam Respipac''', is a [[fluoroquinolone]] [[antibiotic]] used in the treatment of bacterial infections. It has a controversial safety profile.<ref>{{Cite journal  | last1 = Psaty | first1 = BM. | title = Clinical trial design and selected drug safety issues for antibiotics used to treat community-acquired pneumonia. | journal = Clin Infect Dis | volume = 47 Suppl 3 | issue =  | pages = S176-9 |date=Dec 2008 | doi = 10.1086/591400 | PMID = 18986285 | pmc=2587028}}</ref> Zagam is no longer available in the United States.


'''Sparfloxacin''' (spar FLOX a sin), trade names '''Zagam&reg;''' and '''Zagam Respipac''', is a [[fluoroquinolone]] [[antibiotic]] used in the treatment of bacterial infections.  Zagam is no longer available in the United States.
==Pharmacological properties==
Sparfloxacin is about 37-45% bound to proteins in the [[blood]].<ref>{{cite pmid|8287631}}</ref><ref>{{cite pmid|8737123}}</ref>


Sparfloxacin achieves a high degree of penetration into most tissues, except for the central .nervous system. Sparfloxacin is about 37- 45% protein boun;J) (Shimada et at., 1993; Montay,1996). Following a single 400-mg oral dose of sparfloxacin, the mean peak concentration in ~ cantharides-induced inflammatory fluid is 1.3 lA-g per ml after a mean duration of 5 h post-dose. ,J. Thus(overall sparfloxacin penetration into inflammatory fluid is 117% and the mean elimination half-life from this fluid is 19.7 h (Johnson et at., 1992). Skin penetration of sparfloxacin is.good with skin:plasma ratios of 1.00 at 4 h (time of peak plasma concentration) and 1.39 at 5 h. Following single oral doses of 100 or 200mg, concentrations in skin of 0.56 and 0.82-1.31 lA-g per g, respectively, can be expected (Nogita and Ishibashi, 1991 ). Sparfloxacin achieves excellent penetration into human polymorphonuclear leukocytes in vitro (Garcia et at., 1992). Sparfloxacin achieves high concentrations in respiratory and sinus tissues. Following an oral loading dose of 400 mg followed by 200 mg daily, mean concentrations of sparfloxacin (2.5 to 5 h after dosing) in bronchial mucosa, epithelial lining fluid and alveolar macrophages are 4.4 ug per g, 15.0 ug per ml and 53.7 ug per g, respectively. The mean sparfloxacin concentration in maxillary sinus mucosa, 2-5 h after a single 400-mg dose, is 5.8 ug/g (Wise and Honeybourne, 1996)
*Sparfloxacin achieves a high degree of penetration into most tissues, except for the central nervous system.
Shimada et at. ( 1993) has summarized many of the studies published in J apanese regarding the tissue distribution of sparfloxacin. (iligh concentrations are achieved in sputu!J!, pleural fluid, skin, lung, prostate, gynecological tissues, breast milk aJ1d otolaryngological ti~sues. Salivary concentrations are 66-70% of plasma levels, while CSF penetration appears to be somewhat.limited with CSF:plasma concentration ratios of only 0.25-0.35. Sparfloxacin achieves concentrati<>ns in bile and gallbladder of 7.1- to 83-fold the concurrent serum levels;J
*Following a single 400&nbsp;mg oral dose of sparfloxacin, the mean peak concentration in cantharides-induced inflammatory fluid is 1.3 lA-g per ml after a mean duration of 5 h post-dose. Thus(overall sparfloxacin penetration into inflammatory fluid is 117% and the mean elimination half-life from this fluid is 19.7 h.<ref name="pmid1336947">{{cite journal |author=Johnson JH, Cooper MA, Andrews JM, Wise R |title=Pharmacokinetics and inflammatory fluid penetration of sparfloxacin |journal=Antimicrob. Agents Chemother. |volume=36 |issue=11 |pages=2444–6 |date=November 1992 |pmid=1336947 |pmc=284350 |doi= 10.1128/aac.36.11.2444|url=http://aac.asm.org/cgi/pmidlookup?view=long&pmid=1336947 |accessdate=2014-10-15}}</ref>
In rabbits, sparfloxacin achieves very good penetration into the ocular vitreous (54% ), cornea (76%) and lens (36%) (Cochereau-Massin et at., 1993).
*Skin penetration of sparfloxacin is good with skin:plasma ratios of 1.00 at 4 h (time of peak plasma concentration) and 1.39 at 5 h. Following single oral doses of 100 or 200&nbsp;mg, concentrations in skin of 0.56 and 0.82-1.31 lA-g per g, respectively, can be expected.<ref>{{cite pmid|1663927}}</ref> Sparfloxacin achieves excellent penetration into human polymorphonuclear leukocytes ''in vitro''.<ref name="pmid1324636">{{cite journal |author=García I, Pascual A, Guzman MC, Perea EJ |title=Uptake and intracellular activity of sparfloxacin in human polymorphonuclear leukocytes and tissue culture cells |journal=Antimicrob. Agents Chemother. |volume=36 |issue=5 |pages=1053–6 |date=May 1992 |pmid=1324636 |pmc=188834 |doi= 10.1128/aac.36.5.1053|url=http://aac.asm.org/cgi/pmidlookup?view=long&pmid=1324636 |accessdate=2014-10-15}}</ref>
*Sparfloxacin achieves high concentrations in respiratory and sinus tissues. Following an oral loading dose of 400&nbsp;mg followed by 200&nbsp;mg daily, mean concentrations of sparfloxacin (2.5 to 5 h after dosing) in bronchial mucosa, epithelial lining fluid and alveolar macrophages are 4.4&nbsp;µg/g, 15.0&nbsp;µg/ml and 53.7&nbsp;µg/g, respectively. The mean sparfloxacin concentration in maxillary sinus mucosa, 2-5 h after a single 400&nbsp;mg dose, is 5.8&nbsp;µg/g.<ref>{{cite pmid|8737125}}</ref>
Shimada et al. ( 1993) has summarized many of the studies published in Japanese regarding the tissue distribution of sparfloxacin. (high concentrations are achieved in sputum, pleural fluid, skin, lung, prostate, gynecological tissues, breast milk and otolaryngological tissues. *Salivary concentrations are 66-70% of plasma levels, while CSF penetration appears to be somewhat limited with CSF:plasma concentration ratios of only 0.25-0.35.
*Sparfloxacin achieves concentrations in bile and gallbladder of 7.1- to 83-fold the concurrent serum levels.
In rabbits, sparfloxacin achieves very good penetration into the ocular vitreous (54%), cornea (76%) and lens (36%).<ref>{{cite pmid|8388193}}</ref>


Sparfloxacin has a similar rate of adverse reactions as ciprofloxacin and other commonly used fluoroqumolones. In a review of 2081 adult patients participating in a Phase III clinical trial of sparfloxacin in community-acquired, lower respiratory tract infections, sparfloxacin (200- or 4O0-mg loading dose then 100 or 200mg daily; i.e. 200/100mg and 400/200mg) had a similar incidence of adverse events as the comparator agents (Rubinstein, 1996). The overall rates of drug-related adverse reactions for sparfloxacin 400/200mg versus comparators and 200/100mg versus the comparator (amoxycillin/clavulanic acid) were 13.7 versus 17.7%, and 9.5 versus 13.2%, respectively. However, many of these reported reactions were very minor; discontinua- tion of the antibacterial agent because of drug-related adverse reactions occured in 1.6 versus 1.6%, and 1) versus 1.1 %, respectively. Adverse reactions affecting the nervous system were reported in 5.7% of the sparfloxacin group, with insomnia and other sleep disorders the most common events. Phototoxicity was noted in 2.0% of sparfloxacin recipients, with the average delay in onset being 6.3 :t 4.5 days (range 1-14 days) after commencing sparfloxacin. Mostly this comisted of erythema on the face and hands which lasted an average of 6.4 :t 4.2 days. The incidence of phototoxicity associated with sparfloxacin appears to be higher than that observed with ciprofloxacin and ofloxacin but less than that reported for fleroxacin, pefloxacin, enoxacin and nalidixic acid. Most importantly, features of the hemolytic-uremic syndrome such as that associated with temafloxacin (p.II44) have not been reported (Ram say and Obershkova, 1974; Bowie et at., 1989; Davey, 1989; Wolf son and Hooper, 1991; Rubinstein, 1996).
== Medical uses ==
The compound is indicated for treating community-acquired lower respiratory tract infections ([[acute sinusitis]], exacerbations of [[chronic bronchitis]] caused by susceptible bacteria, [[community-acquired pneumonia]]).<ref name="pmid8737134">{{cite journal |author=Rubinstein E |title=Safety profile of sparfloxacin in the treatment of respiratory tract infections |journal=J. Antimicrob. Chemother. |volume=37 Suppl A |issue= |pages=145–60 |date=May 1996 |pmid=8737134 |doi= 10.1093/jac/37.suppl_a.145|url=http://jac.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=8737134 |accessdate=2014-10-15}}</ref><ref name="pmid9098667">{{cite journal |author=Goa KL, Bryson HM, Markham A |title=Sparfloxacin. A review of its antibacterial activity, pharmacokinetic properties, clinical efficacy and tolerability in lower respiratory tract infections |journal=Drugs |volume=53 |issue=4 |pages=700–25 |date=April 1997  |pmid=9098667 |doi= 10.2165/00003495-199753040-00010|url= |accessdate=2014-10-15}}</ref><ref name="pmid9399598">{{cite journal |author=Stein GE, Havlichek DH |title=Sparfloxacin: potential clinical and economic impact in the treatment of respiratory infections |journal=Pharmacotherapy |volume=17 |issue=6 |pages=1139–47 |year=1997 |pmid=9399598 |doi= |url=http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0277-0008&date=1997&volume=17&issue=6&spage=1139 |accessdate=2014-10-15}}</ref><ref name="pmid11790155">{{cite journal |author=Zhanel GG, Ennis K, Vercaigne L, Walkty A, Gin AS, Embil J, Smith H, Hoban DJ |title=A critical review of the fluoroquinolones: focus on respiratory infections |journal=Drugs |volume=62 |issue=1 |pages=13–59 |year=2002 |pmid=11790155 |doi= 10.2165/00003495-200262010-00002|url= |accessdate=2014-10-15}}</ref>


{{QuinoloneAntiBiotics}}
==Adverse drug reactions==
{{See also|Quinolone#Adverse effects}}
*In a review of 2081 adult patients participating in a Phase III clinical trial of sparfloxacin in community-acquired, lower respiratory tract infections, sparfloxacin (200- or 400&nbsp;mg loading dose then 100 or 200&nbsp;mg daily; i.e. 200/100&nbsp;mg and 400/200&nbsp;mg) had a similar incidence of adverse events as the comparator agents (Rubinstein, 1996). The overall rates of drug-related adverse reactions for sparfloxacin 400/200&nbsp;mg versus comparators and 200/100&nbsp;mg versus the comparator (amoxycillin/clavulanic acid) were 13.7 versus 17.7%, and 9.5 versus 13.2%, respectively. However, many of these reported reactions were very minor; discontinua- tion of the antibacterial agent because of drug-related adverse reactions occurred in 1.6 versus 1.6%, and 1) versus 1.1%, respectively. Adverse reactions affecting the nervous system were reported in 5.7% of the sparfloxacin group, with insomnia and other sleep disorders the most common events.
*Phototoxicity was noted in 2.0% of sparfloxacin recipients, with the average delay in onset being 6.3 :t<!--±?--> 4.5 days (range 1&ndash;14 days) after commencing sparfloxacin. Mostly this consisted of erythema on the face and hands which lasted an average of 6.4 :t<!--±?--> 4.2 days. The incidence of phototoxicity associated with sparfloxacin appears to be higher than that observed with ciprofloxacin and ofloxacin but less than that reported for fleroxacin, pefloxacin, enoxacin and nalidixic acid.
*Most importantly, features of the hemolytic-uremic syndrome such as that associated with temafloxacin<ref>(p.&nbsp;II44){{Clarify|date=June 2011}}<!--citation details needed--></ref> have not been reported.<ref>Ramsay and Obershkova, 1974{{Clarify|date=June 2011}}<!--citation details needed--></ref><ref>Bowie et al., 1989{{Clarify|date=June 2011}}<!--citation details needed--></ref><ref>Davey, 1989{{Clarify|date=June 2011}}<!--citation details needed--></ref><ref>Wolfson and Hooper, 1991{{Clarify|date=June 2011}}<!--citation details needed--></ref><ref>{{cite pmid|8737134}}</ref>
 
==Mechanism of action==
Sparfloxacin, like other [[quinolones]] and [[fluoroquinolones]], are bactericidal drugs, actively killing bacteria. Quinolones inhibit the bacterial DNA [[gyrase]] or the [[topoisomerase IV]] enzyme, thereby inhibiting DNA replication and transcription. Quinolones can enter cells easily and therefore are often used to treat intracellular pathogens such as Legionella pneumophila and Mycoplasma pneumoniae. For many gram-negative bacteria DNA gyrase is the target, whereas topoisomerase IV is the target for many gram-positive bacteria. Eukaryotic cells do not contain DNA [[gyrase]] or [[topoisomerase IV]].


[[Category:Fluoroquinolone antibiotics]]
==See also==
*[[Quinolones]]


==References==
{{Reflist|2}}


[[ja:ザガム]]
{{QuinoloneAntiBiotics}}
[[th:สปาร์ฟลอกซาซิน]]


{{WH}}
[[Category:drug]]
{{WikiDoc Sources}}
[[Category:Fluoroquinolone antibiotics]]
[[Category:Withdrawn drugs]]
[[Category:Piperazines]]
[[Category:Cyclopropanes]]

Latest revision as of 17:24, 13 April 2015

Sparfloxacin
Clinical data
AHFS/Drugs.comMicromedex Detailed Consumer Information
MedlinePlusa600002
Pregnancy
category
  • US: C (Risk not ruled out)
Routes of
administration		Oral
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability92%
Protein binding45%
MetabolismHepatic glucuronidation
Cytochrome P450 system not involved
Elimination half-life16 to 30 hours
ExcretionFecal (50%) and renal (50%)
Identifiers
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
E number{{#property:P628}}
ECHA InfoCard{{#property:P2566}}Lua error in Module:EditAtWikidata at line 36: attempt to index field 'wikibase' (a nil value).
Chemical and physical data
FormulaC19H22F2N4O3
Molar mass392.41 g/mol
3D model (JSmol)
  (verify)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Sparfloxacin (spar FLOX a sin), trade names Spacin in Bangladesh, Zagam and Zagam Respipac, is a fluoroquinolone antibiotic used in the treatment of bacterial infections. It has a controversial safety profile.[1] Zagam is no longer available in the United States.

Pharmacological properties

Sparfloxacin is about 37-45% bound to proteins in the blood.[2][3]

  • Sparfloxacin achieves a high degree of penetration into most tissues, except for the central nervous system.
  • Following a single 400 mg oral dose of sparfloxacin, the mean peak concentration in cantharides-induced inflammatory fluid is 1.3 lA-g per ml after a mean duration of 5 h post-dose. Thus(overall sparfloxacin penetration into inflammatory fluid is 117% and the mean elimination half-life from this fluid is 19.7 h.[4]
  • Skin penetration of sparfloxacin is good with skin:plasma ratios of 1.00 at 4 h (time of peak plasma concentration) and 1.39 at 5 h. Following single oral doses of 100 or 200 mg, concentrations in skin of 0.56 and 0.82-1.31 lA-g per g, respectively, can be expected.[5] Sparfloxacin achieves excellent penetration into human polymorphonuclear leukocytes in vitro.[6]
  • Sparfloxacin achieves high concentrations in respiratory and sinus tissues. Following an oral loading dose of 400 mg followed by 200 mg daily, mean concentrations of sparfloxacin (2.5 to 5 h after dosing) in bronchial mucosa, epithelial lining fluid and alveolar macrophages are 4.4 µg/g, 15.0 µg/ml and 53.7 µg/g, respectively. The mean sparfloxacin concentration in maxillary sinus mucosa, 2-5 h after a single 400 mg dose, is 5.8 µg/g.[7]

Shimada et al. ( 1993) has summarized many of the studies published in Japanese regarding the tissue distribution of sparfloxacin. (high concentrations are achieved in sputum, pleural fluid, skin, lung, prostate, gynecological tissues, breast milk and otolaryngological tissues. *Salivary concentrations are 66-70% of plasma levels, while CSF penetration appears to be somewhat limited with CSF:plasma concentration ratios of only 0.25-0.35.

  • Sparfloxacin achieves concentrations in bile and gallbladder of 7.1- to 83-fold the concurrent serum levels.

In rabbits, sparfloxacin achieves very good penetration into the ocular vitreous (54%), cornea (76%) and lens (36%).[8]

Medical uses

The compound is indicated for treating community-acquired lower respiratory tract infections (acute sinusitis, exacerbations of chronic bronchitis caused by susceptible bacteria, community-acquired pneumonia).[9][10][11][12]

Adverse drug reactions

See also: Quinolone § Adverse effects
  • In a review of 2081 adult patients participating in a Phase III clinical trial of sparfloxacin in community-acquired, lower respiratory tract infections, sparfloxacin (200- or 400 mg loading dose then 100 or 200 mg daily; i.e. 200/100 mg and 400/200 mg) had a similar incidence of adverse events as the comparator agents (Rubinstein, 1996). The overall rates of drug-related adverse reactions for sparfloxacin 400/200 mg versus comparators and 200/100 mg versus the comparator (amoxycillin/clavulanic acid) were 13.7 versus 17.7%, and 9.5 versus 13.2%, respectively. However, many of these reported reactions were very minor; discontinua- tion of the antibacterial agent because of drug-related adverse reactions occurred in 1.6 versus 1.6%, and 1) versus 1.1%, respectively. Adverse reactions affecting the nervous system were reported in 5.7% of the sparfloxacin group, with insomnia and other sleep disorders the most common events.
  • Phototoxicity was noted in 2.0% of sparfloxacin recipients, with the average delay in onset being 6.3 :t 4.5 days (range 1–14 days) after commencing sparfloxacin. Mostly this consisted of erythema on the face and hands which lasted an average of 6.4 :t 4.2 days. The incidence of phototoxicity associated with sparfloxacin appears to be higher than that observed with ciprofloxacin and ofloxacin but less than that reported for fleroxacin, pefloxacin, enoxacin and nalidixic acid.
  • Most importantly, features of the hemolytic-uremic syndrome such as that associated with temafloxacin[13] have not been reported.[14][15][16][17][18]

Mechanism of action

Sparfloxacin, like other quinolones and fluoroquinolones, are bactericidal drugs, actively killing bacteria. Quinolones inhibit the bacterial DNA gyrase or the topoisomerase IV enzyme, thereby inhibiting DNA replication and transcription. Quinolones can enter cells easily and therefore are often used to treat intracellular pathogens such as Legionella pneumophila and Mycoplasma pneumoniae. For many gram-negative bacteria DNA gyrase is the target, whereas topoisomerase IV is the target for many gram-positive bacteria. Eukaryotic cells do not contain DNA gyrase or topoisomerase IV.

See also

References

  1. ↑ Psaty, BM. (Dec 2008). "Clinical trial design and selected drug safety issues for antibiotics used to treat community-acquired pneumonia". Clin Infect Dis. 47 Suppl 3: S176–9. doi:10.1086/591400. PMC 2587028. PMID 18986285.
  2. ↑ PMID 8287631 (PMID 8287631)
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  3. ↑ PMID 8737123 (PMID 8737123)
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  4. ↑ Johnson JH, Cooper MA, Andrews JM, Wise R (November 1992). "Pharmacokinetics and inflammatory fluid penetration of sparfloxacin". Antimicrob. Agents Chemother. 36 (11): 2444–6. doi:10.1128/aac.36.11.2444. PMC 284350. PMID 1336947. Retrieved 2014-10-15.
  5. ↑ PMID 1663927 (PMID 1663927)
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  6. ↑ García I, Pascual A, Guzman MC, Perea EJ (May 1992). "Uptake and intracellular activity of sparfloxacin in human polymorphonuclear leukocytes and tissue culture cells". Antimicrob. Agents Chemother. 36 (5): 1053–6. doi:10.1128/aac.36.5.1053. PMC 188834. PMID 1324636. Retrieved 2014-10-15.
  7. ↑ PMID 8737125 (PMID 8737125)
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  8. ↑ PMID 8388193 (PMID 8388193)
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  9. ↑ Rubinstein E (May 1996). "Safety profile of sparfloxacin in the treatment of respiratory tract infections". J. Antimicrob. Chemother. 37 Suppl A: 145–60. doi:10.1093/jac/37.suppl_a.145. PMID 8737134. Retrieved 2014-10-15.
  10. ↑ Goa KL, Bryson HM, Markham A (April 1997). "Sparfloxacin. A review of its antibacterial activity, pharmacokinetic properties, clinical efficacy and tolerability in lower respiratory tract infections". Drugs. 53 (4): 700–25. doi:10.2165/00003495-199753040-00010. PMID 9098667. |access-date= requires |url= (help)
  11. ↑ Stein GE, Havlichek DH (1997). "Sparfloxacin: potential clinical and economic impact in the treatment of respiratory infections". Pharmacotherapy. 17 (6): 1139–47. PMID 9399598. Retrieved 2014-10-15.
  12. ↑ Zhanel GG, Ennis K, Vercaigne L, Walkty A, Gin AS, Embil J, Smith H, Hoban DJ (2002). "A critical review of the fluoroquinolones: focus on respiratory infections". Drugs. 62 (1): 13–59. doi:10.2165/00003495-200262010-00002. PMID 11790155. |access-date= requires |url= (help)
  13. ↑ (p. II44)[clarification needed]
  14. ↑ Ramsay and Obershkova, 1974[clarification needed]
  15. ↑ Bowie et al., 1989[clarification needed]
  16. ↑ Davey, 1989[clarification needed]
  17. ↑ Wolfson and Hooper, 1991[clarification needed]
  18. ↑ PMID 8737134 (PMID 8737134)
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