Moxifloxacin

Indications
 Oral
Acute bacterial sinusitis
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
Community-acquired pneumonia
Adult: 400 mg once daily for 7-14 days.
Oral
Skin and skin structure infections
Adult: Complicated: 400 mg once daily for 7-21 days; uncomplicated: 400 mg once daily for 7 days.
Intravenous
Acute bacterial sinusitis
Adult: 400 mg by IV infusion over 60 minutes every 24 hr for 10 days.
Intravenous
Acute bacterial exacerbation of chronic bronchitis
Adult: 400 mg by IV infusion over 60 minutes every 24 hr for 5-10 days.
Intravenous
Community-acquired pneumonia
Adult: 400 mg by IV infusion over 60 minutes every 24 hr for 7-14 days.
Intravenous
Skin and skin structure infections
Adult: Complicated: 400 mg once daily for 7-21 days; uncomplicated: 400 mg once daily for 7 days. Dose to be infused over 60 minutes.
Intravenous
Intra-abdominal infections
Adult: 400 mg for 5-14 days. May change to oral therapy when clinically appropriate. Dose to be infused over 60 minutes.
Ophthalmic
Bacterial conjunctivitis
Adult: As 0.5% ophthalmic solution: instil 1 drop in the affected eye tid for 7 days.
Child: >1 yr as 0.5% ophthalmic solution: instil 1 drop in the affected eye tid for 7 days.
Contraindications
 Hypersensitivity; child, adolescent; pregnancy, lactation.
Warnings / Precautions
 Maintain adequate fluid intake; exposure to strong sunlight/sunlamp. Epilepsy, history of CNS disorders, DM. Not recommended in severe hepatic impairment. May worsen myasthenia gravis. Discontinue in case of tendon pain, inflammation or rupture. High level of resistance with S. aureus infections. Increased risk of tendon inflammation/rupture especially in elderly taking corticosteroids. Caution in patients with proarrhythmic conditions e.g. clinically significant bradycardia or acute MI. Existing QT prolongation, bradycardia, heart failure with reduced left ventricular ejection fraction; uncorrected hypokalaemia. Avoid concomitant usage with drugs that are known to prolong QT interval. Prolonged use may increase risk of fungal or bacterial superinfection.
Adverse Reactions
 GI disturbances, CNS effects, hypersensitivity-type reactions, reversible arthralgia, abnormal liver function tests, hepatitis, haematological disturbances, tachycardia, superinfection, pain and irritation at the Inj site, tendon damage, phloebitis and thrombophloebitis, peripheral neuropathy, photosensitivity, abdominal pain, headache, vaginitis.
Overdose Reactions
 Stomach should be emptied and hydration maintained. Activated charcoal may be useful soon after oral overdosage. Treatment should be supportive, dialysis may be of some limited use.
Drug Interactions
 Moxifloxacin should be taken 4 hr before or 8 hr after admin of magnesium or aluminium containing antacids or iron and zinc containing products. Increased risk of CNS stimulation and convulsions with NSAIDs. May increase adverse effects of corticosteroids when used together. May increase anticoagulant effect of coumarin derivatives. May reduce serum levels of mycophenolate. Didanosine, sevelamer, sucralfate and quinalapril may reduce the absorption of orally-administered moxifloxacin.
Potentially Fatal: Risk of torsade de pointes with QT prolonging drugs e.g. class Ia or class III antiarrythmics, terfenadine, cisapride, astemizole.
See Below for More moxifloxacin Drug Interactions
Mechanism of Actions
 Moxifloxacin inhibits the topoisomerase II (DNA gyrase) and topoisomerase IV required for bacterial DNA replication, transcription, repair and recombination.
Absorption: Well absorbed from GI tract.
Distribution: Widely distributed throught the body. 30-50% protein bound.
Metabolism: Metabolised via glucuronide and sulfate conjugation.
Excretion: Excreted in urine and faeces as unchanged drug and metabolite. Elimination half life of around 12 hr.
Administration
 May be taken with or without food.
Storage Conditions
 Intravenous: Store at 25°C. Ophthalmic: Store at 2-25°C. Oral: Store at 25°C.
ATC Classification
 J01MA14 - moxifloxacin ; Belongs to the class of fluoroquinolones. Used in the systemic treatment of infections.
S01AX22 - moxifloxacin ; Belongs to the class of other antiinfectives. Used in the treatment of eye infections.
Storage
 Intravenous: Store at 25°C. Ophthalmic: Store at 2-25°C. Oral: Store at 25°C.
Available As
  • Moxifloxacin 0.3%
  • Moxifloxacin 0.3% w/v
  • Moxifloxacin 0.5 mg
  • Moxifloxacin 0.5%
  • Moxifloxacin 0.5% w/v
  • Moxifloxacin 0.5% w/w
  • Moxifloxacin 0.50% w/v
  • Moxifloxacin 400 mg
  • Moxifloxacin 5 mg
  • Moxifloxacin 5%
  • Moxifloxacin 5% w/v

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