Moxifloxacin

Oral
Intravenous
Ophthalmic
Class
Antibiotics
Subclass
Fluoroquinolones
Substance name
Moxifloxacin hydrochloride
Brand names
Avelox®
Common formulations
Film-coated tablet
Dosage and administration
Adults patients
Treatment
Acute bacterial rhinosinusitis
•
400 mg PO daily for 10 days
Community-acquired pneumonia
•
400 mg PO daily for at least 5 days, up to 14 days
COPD • Acute exacerbation
•
400 mg PO daily for 5 days
Intra-abdominal infections • Complicated
•
400 mg PO daily for 5-14 days
SSTIs • Uncomplicated
•
400 mg PO daily for 7 days
SSTIs • Complicated
•
400 mg PO daily for 7-21 days
Acute diverticulitis • Uncomplicated, outpatient, symptoms persisting or worsening after 48-72 hours • Off-label
•
400 mg PO daily for 7-10 days
Diabetic foot infection • Off-label
•
400 mg PO daily for 1-2 weeks, up to 3-4 weeks in severe cases
Mycoplasma genitalium • Macrolide-resistant or resistance testing unavailable • Off-label
•
400 mg PO daily for 7 days
Administered after an initial treatment with doxycycline 100 mg orally BID for 7 days.
Osteomyelitis • Native vertebral, caused by Enterobacterales or other susceptible aerobic Gram-negative organisms • Off-label
•
400 mg PO daily for 6 weeks
Pelvic inflammatory disease, if cephalosporins are ineffective or contraindicated • Off-label
•
400 mg PO daily for 14 days
Administered in combination with metronidazole 500 mg orally BID.
Peritoneal dialysis-associated peritonitis • Off-label
•
400 mg PO daily
Tuberculosis • Off-label
•
400 mg PO daily
Administered as part of anti-tuberculosis regimens.
Prevention and treatment
Prevention and treatment of plague
•
400 mg PO daily for 10-14 days
Indications for use
Labeled indications
Adults
•
Treatment of acute bacterial rhinosinusitis
•
Treatment of COPD (acute exacerbation)
•
Treatment of community-acquired pneumonia
•
Treatment of intra-abdominal infections (complicated)
•
Treatment of SSTIs (complicated)
•
Treatment of SSTIs (uncomplicated)
•
Prevention and treatment of plague
Off-label indications
Adults
•
Treatment of Mycoplasma genitalium (macrolide-resistant or resistance testing unavailable)
•
Treatment of acute diverticulitis (uncomplicated, outpatient, symptoms persisting or worsening after 48-72 hours)
•
Treatment of diabetic foot infection
•
Treatment of osteomyelitis (native vertebral, caused by Enterobacterales or other susceptible aerobic Gram-negative organisms)
•
Treatment of pelvic inflammatory disease, if cephalosporins are ineffective or contraindicated
•
Treatment of peritoneal dialysis-associated peritonitis
•
Treatment of tuberculosis
Safety risks
Boxed warnings
Exacerbation of myasthenia gravis
•
Avoid using moxifloxacin in patients with myasthenia gravis.
Tendinitis, tendon rupture, peripheral neuropathy, CNS adverse events
•
Maintain a high level of suspicion, as fluoroquinolones, including moxifloxacin, have been associated with an increased risk of disabling and potentially irreversible serious adverse reactions that can occur together, including tendinitis and tendon rupture (most commonly affecting the Achilles tendon), peripheral neuropathy, and CNS effects (including convulsions, increased ICP, and psychosis). Reserve moxifloxacin for acute exacerbation of COPD and acute bacterial rhinosinusitis only when no alternative treatment options are available. Discontinue moxifloxacin immediately and avoid the use of fluoroquinolones in patients who experience any of these serious adverse reactions.
Contraindications
Hypersensitivity to moxifloxacin or its components or to other quinolones
Known or at risk of QT prolongation
•
Avoid using moxifloxacin in patients with known QT prolongation, ventricular arrhythmia (including torsade de pointes), ongoing proarrhythmic conditions (such as clinically significant bradycardia and acute myocardial ischemia), uncorrected hypokalemia or hypomagnesemia, receiving class IA (such as quinidine, procainamide) or class III (such as amiodarone, sotalol) antiarrhythmics or other QT-prolonging drugs (such as cisapride, erythromycin, antipsychotics, or TCAs).
Warnings and precautions
Antimicrobial resistance
•
Maintain a high level of suspicion, as the use of moxifloxacin in the absence of a proven or strongly suspected bacterial infection increases the risk of developing drug-resistant bacteria.
Aortic aneurysm, aortic dissection
•
Maintain a high level of suspicion, as fluoroquinolones, including moxifloxacin, have been associated with an increased risk of aortic aneurysm and dissection within two months of use, particularly in elderly adults. Use moxifloxacin in patients with a known aortic aneurysm or at risk of aortic aneurysms only when no alternative antibacterial treatments are available.
C. difficile infection
•
Maintain a high level of suspicion, as nearly all antibiotics, including moxifloxacin, are associated with an increased risk of C. difficile-associated diarrhea.
Decreased blood glucose, increased blood glucose
•
Maintain a high level of suspicion, as fluoroquinolones, including moxifloxacin, can cause both hypoglycemia and hyperglycemia.
Photosensitivity of skin
•
Maintain a high level of suspicion, as fluoroquinolones, including moxifloxacin, can cause moderate-to-severe photosensitivity/phototoxicity reactions. Advise avoiding excessive exposure to sun or UV light.
Severe adverse reactions
•
Maintain a high level of suspicion, as fluoroquinolones, including moxifloxacin, have been associated with an increased risk of serious and sometimes fatal adverse reactions, including severe cutaneous adverse reactions, vasculitis, serum sickness, hypersensitivity pneumonitis, interstitial nephritis, AKI, hepatitis, hepatic necrosis, hemolytic or aplastic anemia, and TTP.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
Renal replacement therapy
Any modality
•
Use acceptable. No dose adjustment required.
Hepatic impairment
Any severity
•
Use acceptable. No dose adjustment required. Monitor for QT prolongation.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B3
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals.
Breastfeeding
Use only if benefits outweigh potential risks.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Common 1-10%
•
Anemia, ↑ blood neutrophil count, ↑ WBC count, ↑PT, ↑ serum calcium, ↑ serum TBIL, ↓ blood neutrophil count, ↑ blood glucose, ↑ serum amylase, diarrhea, dizziness, dyspepsia, fever, ↑ serum ALT, ↓ serum potassium, headache, nausea, vomiting, constipation, abdominal pain, insomnia
Uncommon < 1%
•
Atrial fibrillation, heart failure, cardiac arrest, gastritis, gastroesophageal reflux disease, candidiasis, gastroenteritis, fungal infections, renal failure, ↑ platelet count, ↑ blood eosinophil count, ↓ WBC count, palpitations, angina pectoris, tachycardia, bradycardia, vertigo, tinnitus, dry mouth, blurred vision, abdominal discomfort, flatulence, abdominal distension, fatigue, chest pain, malaise, asthenia, edema, chills, facial pain, chest discomfort, ↑ LFTs, ↑ serum AST, ↑ serum gamma-glutamyltransferase, ↑QT interval, ↑ serum ALP, ↑ serum LDH, ↑ serum lipase, ↑ serum creatinine, ↑ BUN, ↓ hematocrit, ↑PTT, ↑ serum triglycerides, ↑ serum uric acid, loss of appetite, ↓ blood glucose, dehydration, back pain, ↑ serum cholesterol, arthralgia, pain in extremity, musculoskeletal pain, muscle spasms, dysgeusia, somnolence, tremor, lethargy, paresthesia, hypoesthesia, syncope, anxiety, confusion, agitation, depression, nervousness, restlessness, hallucinations, disorientation, dysuria, dyspnea, vaginal itching, wheezing, bronchospasm, skin rash, pruritus, skin erythema, hyperhidrosis, urticaria, night sweats, hypertension, hypotension, phlebitis
Unknown frequency
•
Agranulocytosis, pancytopenia, ventricular arrhythmia, hearing loss, vision loss, jaundice, angioedema, incoordination, gait disturbance, peripheral neuropathy, psychosis, photosensitivity of skin, myalgia, hepatitis, acute liver failure, hepatic necrosis, anaphylaxis, tendon rupture, hypersensitivity pneumonitis, interstitial nephritis, Stevens-Johnson syndrome, toxic epidermal necrolysis, aortic aneurysm, aortic dissection, Clostridioides difficile infection, aplastic anemia, hemolytic anemia, thrombocytopenia purpura, serum sickness, vasculitis
Interactions
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