Adult: 400 mg once daily given via infusion over 60 minutes for 5-14 days.
Intravenous Complicated skin and skin structure infections
Adult: 400 mg once daily given via infusion over 60 minutes for 7-21 days.
Intravenous Acute bacterial exacerbation of chronic bronchitis
Adult: 400 mg once daily given via infusion over 60 minutes for 5 days.
Intravenous Uncomplicated skin and skin structure infections
Adult: 400 mg once daily given via infusion over 60 minutes for 7 days. Child: ≥1 yr Same as adult dose.
Intravenous Community-acquired pneumonia
Adult: 400 mg once daily given via infusion over 60 minutes for 7-14 days.
Intravenous Acute bacterial sinusitis
Adult: 400 mg once daily given via infusion over 60 minutes for 10 days.
Ophthalmic Bacterial conjunctivitis
Adult: As 0.5% solution: Instill 1 drop into the affected eye(s) tid for 7 days.
Oral Community-acquired pneumonia
Adult: 400 mg once daily for 10 days.
Oral Acute bacterial exacerbation of chronic bronchitis
Adult: 400 mg once daily for 5-10 days.
Oral Acute bacterial sinusitis
Adult: 400 mg once daily for 7 days.
Oral Pelvic inflammatory disease
Adult: In combination with another antibacterials in mild to moderate cases: 400 mg once daily for 14 days.
Oral Complicated skin and skin structure infections
Adult: 400 mg once daily for 7-21 days.
Administration
May be taken with or without food.
Incompatibility
10% and 20% NaCl solution, 4.2% and 8.4% Na bicarbonate solution.
Contraindications
Hypersensitivity to moxifloxacin or other quinolone antibiotics. Patient with history of tendon disorders, myasthenia gravis, QT interval prolongation, ventricular arrhythmias, proarrhythmic conditions (e.g. bradycardia, acute MI), peripheral neuropathy, uncorrected electrolyte disorders (e.g. hypokalaemia, hypomagnesemia). Concomitant use with Class 1A and Class III antiarrhythmics, antihistamines, and other drugs that prolong QT interval (e.g. cisapride, erythromycin, antipsychotics, and TCA).
Special Precautions
Patient with known or suspected CNS disorders (e.g. seizure disorder) or other risk factors predisposing to seizures, solid organ transplant recipients, significant bradycardia or acute myocardial ischaemia, diabetes mellitus, rheumatoid arthritis, G6PD, psychiatric disease. Renal and hepatic impairment. Elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Hypersensitivity reactions (e.g. anaphylaxis, shock). Superinfections, hyperglycaemia, pseudomembranous colitis or Clostridium difficile-associated diarrhoea, irreversible tendinitis, tendon rupture, CNS effects (e.g. peripheral neuropathy, seizures, anxiety, depression, delirium, hallucination), leukopenia, neutropenia, thrombocytopenia. Blood and lymphatic system disorders: Anaemia. Ear and labyrinth disorders: Tinnitus. Eye disorders: Eye irritation, conjunctivitis, decreased visual acuity, eye pain and discomfort, eye pruritus, lacrimation, ocular hyperemia, subconjunctival haemorrhage, xerophthalmia. Gastrointestinal disorders: Nausea, vomiting, abdominal pain. General disorders and administration site conditions: Hyperhidrosis. Hepatobiliary disorders: Jaundice. Metabolism and nutrition disorders: Hyperlipidaemia, dehydration, anorexia. Musculoskeletal and connective tissue disorders: Arthralgia, myalgia. Nervous system disorders: Headache, dizziness, insomnia, confusion. Psychiatric disorders: Disturbances in attention, disorientation, agitation, nervousness, memory impairment. Skin and subcutaneous tissue disorders: Rash, pruritus. Vascular disorders: Vasculitis. Potentially Fatal: Hypoglycaemia, fulminant hepatitis. Rarely, QT prolongation and ventricular arrhythmias (including torsades de pointes), bullous skin reactions (e.g. Stevens-Johnson syndrome, toxic epidermal necrolysis).
This drug may cause dizziness and transient loss of vision, if affected, do not drive or operate machinery. Avoid excessive exposure to sunlight or artificial UV light (e.g. tanning beds) and use protective measures (e.g. sunscreen, wear loose-fitting clothes) if staying outdoors during therapy. Remove contact lenses prior to ophth admin.
Monitoring Parameters
Monitor for hypersensitivity reactions, signs and symptoms of infection. Monitor CBC, ECG, LFT and blood glucose levels closely.
Overdosage
Symptoms: QT prolongation. Management: Administer activated charcoal immediately after absorption. Perform ECG monitoring.
Drug Interactions
Increased risk of bradycardia with potassium-reducing agents (e.g. loop diuretics). Increased risk of tendon disorder with corticosteroids. Decreased absorption by forming chelates with antacids containing Al, Mg, Fe, sucralfate and multivalent cations. May enhance anticoagulant effects of warfarin. Potentially Fatal: Increased risk of QT prolongation with class IA (e.g. quinidine) and class III (e.g. amiodarone) antiarryhthmics, terfenadine, cisapride, erythromycin, antipsychotics (e.g. haloperidol), and TCA (e.g. amitriptyline).
Lab Interference
May produce a false-positive urine screening result with opioids.
Action
Description: Mechanism of Action: Moxifloxacin is a fluoroquinolone anti-infective agent, which inhibits bacterial topoisomerase IV and DNA gyrase (topoisomerase II) enzymes which are essential for bacterial DNA replication, transcription, repair and recombination thereby impeding bacterial growth. Pharmacokinetics: Absorption: Readily absorbed from the gastrointestinal tract. Absolute bioavailability: Approx 90%. Distribution: Rapidly distributed to extravascular spaces. Volume of distribution: 1.7-2.7 L/kg. Plasma protein binding: Approx 30-50%. Metabolism: Metabolised in the liver via glucuronide and sulfate conjugation. Excretion: Via urine (20% as unchanged drug, glucuronide conjugate); faeces (25% as unchanged drug, sulfate conjugate). Elimination half-life: Approx 12 hours.
Chemical Structure
Moxifloxacin Source: National Center for Biotechnology Information. PubChem Database. Moxifloxacin, CID=152946, https://pubchem.ncbi.nlm.nih.gov/compound/Moxifloxacin (accessed on Jan. 23, 2020)
S01AE07 - moxifloxacin ; Belongs to the class of quinolone antiinfectives. Used in the treatment of eye infections. J01MA14 - moxifloxacin ; Belongs to the class of fluoroquinolones. Used in the systemic treatment of infections.
References
Anon. Moxifloxacin (Ophthalmic). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 17/08/2018.Anon. Moxifloxacin (Systemic). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 17/08/2018.Avelox Injection Solution, Tablet, Film Coated (Bayer Healthcare Pharmaceuticals Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 11/09/2018.Avelox Tablets. U.S. FDA. https://www.fda.gov/. Accessed 14/05/2014.Avelox. U.S. FDA. https://www.fda.gov/. Accessed 14/05/2014.Buckingham R (ed). Moxifloxacin Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 17/08/2018.Joint Formulary Committee. Moxifloxacin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 17/08/2018.McEvoy GK, Snow EK, Miller J et al (eds). Moxifloxacin Hydrochloride (EENT). AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 14/05/2014.McEvoy GK, Snow EK, Miller J et al (eds). Moxifloxacin Hydrochloride. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 14/05/2014.Moxifloxacin Ophthalmic Solution 0.5% (Aurobindo Pharma Limited). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 17/08/2018.Vigamox Solution (Alcon Laboratories, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 14/05/2014.
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