KEY POINTS
- Moxifloxacin (Avelox) is a fluoroquinolone antibiotic that interferes with bacterial DNA synthesis in susceptible organisms by inhbiting DNA gyrase (topoisomerase II) and topoisomerase IV
- Possess anti-anaerobic activity
- Considered a “respiratory fluoroquinolone” because of its activity versus Streptococcus pneumoniae, the most common cause of community acquired pneumonia
- Possess activity versus atypical organisms such as Legionella sp. and Mycoplasma sp.
- Not considered a good drug for urinary tract infections, although 20% is excreted in urine as unchanged drug
- Available in oral and injectable formulations
- Oral formulation will bind to cations (e.g., calcium) so do not administer concomitantly with milk, calcium carbonate or other things that may bind to moxifloxacin and prevent its absorption
- Common dose is 400mg daily (IV or PO)
- No need to adjust dose for kidney dysfunction
- Per FDA, should only be used when benefits outweigh potential risks if treating acute sinusitis, acute bronchitis or uncomplicated urinary tract infections
- FDA boxed warnings: tendonitis, tendon rupture, CNS effects, peripheral neuropathy, can worsen existing myasthenia gravis
- FDA warnings: hypoglycemia (including coma), altered mental health, aortic dissection
- Other ADRs to beware: QTC prolongation, photosensitivitity
- Suicidal thoughts added to drug safety label warning by the FDA in February 2017
RESOURCES
- Moxifloxacin Oral Package Insert
- Moxifloxacin Intravenous Package Insert
- IDSA Practice Guidelines
- Surgical Prophylaxis Guidelines
- Mayo Clinic Proceedings Fluoroquinolone Review 1999
- Collateral Dammage Fluoroquinolones
- Fluoroquinolone Black Boxed Warnings Review (2016)