Maintain adequate fluid intake; Patient w/ previous tendon disorders (e.g. rheumatoid arthritis), significant bradycardia or acute myocardial ischaemia, heart failure w/ reduced LVEF, known history of symptomatic arrhythmias, known or suspected CNS disorders (e.g. severe cerebral arteriosclerosis, epilepsy) or other risk factors that predispose to seizures; diabetes. Kidney, heart or lung transplant recipients. Hepatic impairment. Pregnancy and lactation.
Patient Counselling This drug may cause dizziness and lightheadedness, if affected do not drive or operate machinery. Rest and refrain from doing strenuous physical activity as it may increase risk of tendon rupture. Avoid exposure to sunlight or artificial UV light (e.g. tanning beds, UVA/UVB treatment) and use protective measures (e.g. sunscreen, wear loose-fitting clothes) if staying outdoors is necessary during therapy. Monitoring Parameters Monitor WBC and signs of infection.
Indication
Community Acquired Pneumonia, Acute Bacterial Exacerbation of Chronic Bronchitis, Acute Bacterial Sinusitis, Complicated Intra-Abdominal Infection, Uncomplicated Skin and Skin Structure Infections, Complicated Skin and Skin Structure Infections, Typhoid Fever.
Contra Indication
Known hypersensitivity to moxifloxacin, other quinolones. Patients w/ known prolongation of QT interval, uncorrected hypokalaemia, myasthenia gravis. Concurrent use of class Ia (e.g.quinidine, procainamide, class III (e.g. amiodarone, sotalol) antiarrhythmic drugs or w/ other drugs that prolong QT interval (e.g. erythromycin, TCAs, antipsychotic agents).
FDA has not yet classified the drug into a specified pregnancy category.
Mode of Action
Moxifloxacin inhibits the topoisomerase II (DNA gyrase) and topoisomerase IV required for bacterial DNA replication, transcription, repair and recombination.
Interaction
Additive effect on QT interval prolongation w/ other drugs that prolong QT interval (e.g. erythromycin, TCAs, antipsychotic agents). Decreased absorption and bioavailability w/ Al- or Mg-containing antacids, or Fe or Zn preparations. Concomitant use of corticosteroids increases the risk of severe tendon disorders esp in elderly (>60 yr). Decreased absorption w/ sucralfate or didanosine.
Potentially Fatal: Concurrent use of class Ia (e.g. quinidine, procainamide) or III (e.g. amiodarone, sotalol) antiarrhythmic drugs or w/ other drugs that prolong QT interval (e.g. erythromycin, TCAs, antipsychotic agents) may cause additive effect on QT interval prolongation.
Pregnancy Category Note
Pregnancy
There are no available human data establishing a drug associated risk; however, when moxifloxacin was administered to rats during pregnancy and throughout lactation at doses associated with maternal toxicity, decreased neonatal body weights, increased incidence of skeletal variations (rib and vertebra combined), and increased fetal loss were observed
Advise pregnant women of potential risk to fetus
Lactation
Not known if moxifloxacin is present in human milk
Based on animal studies in rats, moxifloxacin may be excreted in human milk
Developmental and health benefits of breastfeeding should be considered along with mother?s clinical need for therapy and any potential adverse effects on the breastfed child from drug or from the underlying maternal condition
Adult Dose
Moxifloxacin 400 mg IV infusion can be administered intravenously once daily for 5-21 days, depending on the condition.
The duration of therapy depends on the type of infection as described bellow-
Intravenous
Acute bacterial sinusitis
Adult: 400 mg once daily infused over 60 min for 10 days.
Acute bacterial exacerbation of chronic bronchitis
Adult: 400 mg once daily infused over 60 min for 5 days.
Community-acquired pneumonia
Adult: 400 mg once daily infused over 60 min for 7-14 days.
Skin and skin structure infections
Adult: Complicated: 400 mg once daily for 7-21 days; uncomplicated: 400 mg once daily for 7 days. Doses to be infused over 60 min.
Intra-abdominal infections
Adult: 400 mg once daily infused over 60 min for 5-14 days. May change to oral therapy when clinically appropriate.
Elderly:
No adjustment of dosage is required in the elderly.
Child Dose
<18 years: Safety and efficacy not established
Renal Dose
N/A
Administration
IV Preparation
No further dilution of infusion solution is necessary
IV Administration
Infuse over 1 hour
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