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Moxifloxacin - Indications, Dosage, and Side Effects

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Moxifloxacin treats bacterial infections like pneumonia, skin infections, bacterial sinusitis, and chronic bronchitis. Read the article to learn more.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At March 22, 2023
Reviewed AtSeptember 11, 2023

Overview

Moxifloxacin is used to treat many bacterial infections. It is categorized under the quinolone type of antibiotic. It works by inhibiting the growth of bacteria. It works on bacterial infections only. It treats bacterial infections like pneumonia, sinusitis, conjunctivitis, plague, etc. It also treats bronchitis infections but not the common cold or flu. It can be administered through Injection or taken orally. It has shown a few adverse effects, like peripheral neuropathy, tendinitis, and central nervous system effects.

What Are the Indications of Moxifloxacin?

Moxifloxacin is used to treat infections in adults who are 18 years old and older too. There are a few conditions that are treated by using Moxifloxacin. They are:

  • Community-Acquired Pneumonia - It is indicated for adult patients suffering from community-acquired pneumonia caused by against like Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Klebsiella pneumoniae, and Mycoplasma pneumoniae.

  • Skin Structure Infections - It is used in adult patients when methicillin-susceptible staphylococcus aureus or streptococcus pyogenes causes skin infections.

  • Complicated Intra-Abdominal Infections - It is used against E.coli, Bacteroides fragilis, Streptococcus anginosus, Streptococcus constellatus, Enterococcus faecalis, Clostridium, Bacteroides thetaiotaomicron, or Peptostreptococcus species.

  • Plague - It is used in the treatment of plague and against the Yersinia pestis.

  • Acute Bacterial Sinusitis - It is caused against Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

  • Acute Bacterial Exacerbation of Chronic Bronchitis - It is used to treat chronic bronchitis and used against bacteria like Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae, and staphylococcus aureus.

Moxifloxacin is used only to treat specific infections caused by specific bacteria instead of using it for other infections and against other bacteria.

Dosage:

  • Dosage Form: It is available in tablets and injections. Tablets are dull red with a film coat, and injections are intravenous solutions in yellow color in 0.8% sodium chloride hydrochloride. They come in ready-to-use flexibags.

  • Dosage Strength: Tablets are 400 milligrams.

  • Injections of Moxifloxacin hydrochloride is 0.8 percent sodium chloride solution in 250 milliliters.

Administration:

  • Tablets: Administer the Moxifloxacin either 8 hours after or at least 4 hours before the intake of the product. Products containing iron, magnesium, aluminum, zinc, multivitamins, antacids, and didanosine are not recommended to take along with them.

  • With Food: It can be taken with or without any food.

  • Injections: It is given by intravenous infusion, not by any other means like intramuscular or intraperitoneal. Administer the Injection within 60 minutes or by Y intravenous infusion. Rapid and bolus are inhibited in these cases.

Drug and Diluent Compatibilities:

Moxifloxacin injections are compatible with the solutions that are at ratios from 1:10 to 10:1. Some of the diluents are:

  • 0.9% sodium chloride injections

  • One molar Sodium Chloride injection.

  • 5% Dextrose injection, USP.

  • Sterile water for injections, USP.

  • 10% Dextrose for Injections, USP.

  • Lactated ringers for Injection.

Preparation and Administration:

  • Moxifloxacin injections are prepared b premixing in flexible containers.

  • The flow control clamp is closed for administration.

  • The cover is removed from the bottom of the container.

  • By inserting the piercing pin from the transfer setup.

Contraindications:

  • Moxifloxacin hydrochloride is contraindicated in patients hypersensitive to Moxifloxacin hydrochloride or other Fluoroquinolones.

Warning and Precautions:

  • Prolongation of QT Intervals: In some cases, QT intervals are prolonged. So, the use of Moxifloxacin is avoided in patients who are dealing with acute myocardial ischemia, hypokalemia, hypomagnesemia, and also with drugs that can increase the QT interval.

  • Serious Adverse Effects: Fluoroquinolones have shown some serious adverse effects like tendinitis, tendon rupture, arthralgia, myalgia, peripheral neuropathy, and central nervous system effects like depression and insomnia. The patient suffering from such effects on using Moxifloxacin should avoid its use.

  • Tendinitis and Tendon Rupture: The patient using Moxifloxacin is at a high risk of tendinitis and peripheral neuropathy, so the patient already dealing with tendinitis and peripheral neuropathy should avoid its use.

  • Central Nervous System Effects: The use of Moxifloxacin is also associated with convulsions, depression, confusion, tremors, hallucinations, and suicidal thoughts. If any patient develops, any such symptoms should consult the doctor soon.

  • Exacerbation of Myasthenia Gravis: Fluoroquinolones usually block neuromuscular activities and increase muscle weakness. Any patient dealing with muscle weakness should avoid it.

  • Hypersensitivity and Other Serious Reactions: Sometimes, after using Moxifloxacin, some serious reactions like anaphylactic reactions can occur. Discontinuing the drug can also cause hypersensitivity reactions.

  • Clostridium Difficile-Associated Diarrhea: Sometimes, the use of Moxifloxacin can cause diarrhea.

  • Arthropathic Effects in Animals: Arthropathy in animals (immature dogs) has been reported in cases where an intake of Moxifloxacin causes erosion of joints, especially in weight-bearing areas of the joint.

  • Blood Glucose Variation: As the use of Moxifloxacin has resulted in changes in blood glucose levels, it can be hypoglycemia, and it can be hyperglycemia. So, the diabetic patient is carefully monitored on the use of Moxifloxacin.

  • Photosensitivity: Fluoroquinolones on using them can cause sunburn on UV light exposure, so Moxifloxacin uses patients are avoided direct exposure of sun rays as it causes photosensitivity in them.

  • Development of Drug Resistance: If Moxifloxacin is used against the less healthy bacteria, it will use to inhibit the bacteria but can show resistance against bacteria.

Adverse Reactions:

The adverse reactions related to the use of Moxiflocin are:

  • Nausea.

  • Diarrhea.

  • Headache.

  • Dizziness.

  • Tendinitis and tendon rupture.

  • Peripheral neuropathy.

  • Central nervous system effects show convulsions, depression, hallucinations, and insomnia.

  • Exacerbation of myasthenia gravis.

  • Blood glucose levels change.

  • Photosensitivity.

  • QT interval is prolonged.

  • Hypersensitivity reactions.

  • Diarrhea associated with clostridium difficile

  • Drug-resistant bacteria.

Drug Interactions:

  • When antacids, sucralfate, and multivitamins, along with Moxifloxacin, can lower the absorption of the Moxifloxacin. So, if such medications are used with Moxifloxacin, the patient should take the medicine 4 hours before their intake or 8 hours after these medicines.

  • When Warfarin is used along with Moxifloxacin, anticoagulant effects are seen to be increased, and the monitoring of the prothrombin time and bleeding is done.

  • When antiarrhythmics are taken along with Moxifloxacin, proarrhythmic effects are seen.

  • Antidiabetic agents, when taken along with Moxifloxacin, the patient's blood glucose levels need close monitoring.

Special Considerations:

  • Pregnancy: The use of Moxiflocin in pregnant women is not recommended as it can cause fetal harm on use. The studies conducted have presented the risk to the fetus on the usage of the drug.

  • Nursing Mothers: The drug is excreted in the mother's breastmilk, but it can harm the baby. So, the patient should avoid breastfeeding until the drug is taken.

  • Pediatric Patients: The safety and effectiveness of Moxifloxacin have not been determined in pediatric patients who are under 18 years.

  • Geriatrics: Older people are not used along with Moxifloxacin because it causes a risk of tendon disorders with an increase in corticosteroid therapy and prolonged QT intervals.

  • Renal Impairment: There is no requirement for dose adjustment in the renal impairment patient.

  • Hepatic Impairments: There is no dosage adjustment required in hepatic impairment patients, but its use does lead to QT prolongation in these patients.

For Patients:

Moxifloxacin is used against some bacteria like Streptococcus pyogenes, which causes pneumonia, skin, or other infections. It is used to treat conditions like pneumonia, plague, skin infections, abdominal infection, chronic bronchitis, and bacterial sinusitis. It is categorized under Fluoroquinolones. Although Moxifloxacin does not work for viral infections like the common cold, if the use of Moxifloxacin is done in such minor cases, it can cause antibiotic resistance, as medicine will not work for other major infections caused by bacteria.

How Is It Taken?

Moxifloxacin is taken by mouth. It can be used with or without food but taken only once a day for at least five days or till 21 days, as recommended by the doctor. As the length of treatment is according to the infection of the patient. The medicine is taken every day at a specific time. The patient should also take medicine as recommended by the doctor. Do not take less or more without consulting the doctor. And also, the patient should not stop taking medicine without consulting as it can show side effects.

What Are the Other Uses of Moxifloxacin Medicine?

Moxifloxacin is also used to treat tuberculosis, sexually transmitted diseases (STDs), endocarditis (infection of heart valves and lining), anthrax (serious infection on spreading while bioterror attack), salmonella and shigella (both causing diarrhea), and human immunodeficiency virus (HIV) infections.

What Are the Precautions Taken Before Having Moxifloxacin Medicine?

  • The patient should inform if the patient is allergic to Moxifloxacin or Fluoroquinolones like Ciprofloxacin.

  • The patient should inform the doctor if the patient has other medicines like vitamins, an anti-inflammatory drug, or antidiabetics.

  • The patient should also inform if the patient is on antacids, sucralfate, or vitamin supplements.

  • The doctor should be informed if the patient's family history suffers from QT interval prolongation.

  • The patient should inform the doctor if the patient has an irregular heartbeat, high blood pressure, Marfan syndrome, and Ehlers-Danlos syndrome.

  • The patient should inform about the pregnancy or if they plan to breastfeed.

  • The patient avoided exposure to sunlight.

  • The patient is recommended not to drive the car after having the Moxifloxacin medicine.

What if the Patient Forgets to Take Medicine?

If the patient forgets to take medicine on time, then the patient should take it as soon as on remembering, but if the timing of the next dose is near, then the patient should skip the missed dose and go for the regular next scheduled dose without having the double doses.

What Are the Side Effects of Moxifloxacin Medicine?

Side effects are

There are some side effects that need an immediate doctor's attention. Such side effects are:

  • Severe diarrhea.

  • Rash.

  • Hives.

  • Itchiness.

  • Blistering of the skin.

  • Fever.

  • Swelling of eyes.

  • Hoarseness of voice.

  • Difficulty in breathing.

  • Yellowish, pale skin.

  • Extreme thirst or hunger.

  • Loss of consciousness.

  • Decreased urinary output.

  • Unusual bruising.

  • Unusual bleeding.

  • Chest pain.

  • Stomach pain.

  • Back pains.

  • Bones, joints, and tissues problems.

How to Store and Dispose of the Medicine?

The storage of the medicine is done in closely tight containers. Kept at room temperature, away from heat and moisture. It should be kept away from the reach of children.

The unwanted medicine is disposed of in a very special way so that no one can unknowingly consume it. A take-back medicine program disposes of it. The food and Drug Administration (FDA) have more information regarding it on its site. Instead of flushing or throwing the medicine, such programs help to avoid the intake of medicine by any pet, children, or people unknowingly, as it can be harmful to them.

What if the Patient Has an Overdose?

The patient dealing with overdosage will show symptoms like seizures and troublesome breathing, requiring an immediate doctor's attention.

For Doctors:

Moxifloxacin:

Moxifloxacin hydrochloride is an antibacterial agent which is used to inhibit bacterial infections. It is taken either orally or intravenously. It is fluoroquinolone with a monohydrochloride salt 1-cyclopropyl-7-[(S, S)-2,8-diazabicyclo[4.3.0]non-8-methoxy-1,4-dihydro-4-oxo-3 quinoline carboxylic acid. It has a color slightly yellow to yellowish crystalline and a molecular weight of 437.9. It has an empirical formula of C21H24FN3O4*HCl.

What Is the Clinical Pharmacology of Moxifloxacin?

Pharmacodynamics: Moxifloxacin studies have reported cases of photosensitivity as the skin responds to ultraviolet rays.

Pharmacokinetics:

  • Absorption: Moxifloxacin is taken orally and is absorbed in the gastrointestinal tract. There is a 90% bioavailability of Moxifloxacin. It can be taken with high-fat diet meals. The plasma concentration reaches up to the highest dose by increasing proportionally.

  • Distribution: Moxifloxacin binds 50 to 60% with the serum proteins. The range of Moxifloxacin is 1.7 to 2.7 liters per kilogram. It got widely distributed in saliva, nasal and bronchial secretions.

  • Metabolism: 52% of Moxifloxacin is metabolized by glucuronide and sulfate.the sulfate that conjugates forms M1 the 38% and is excreted in feces. And M2, only 14% of the remaining oral or intravenous dose is converted to form glucuronide conjugates and excreted in the urine. The plasma concentration of the M2 is 40%, and M1 is 10% of the Moxifloxacin.

  • Excretion: 45% of Moxifloxacin is excreted in urine and feces. The elimination half-life of the Moxifloxacin is 12 hours.

Pharmacokinetics in Specific Populations:

  • Geriatric: There is no need for dose adjustment in elderly patients for Moxifloxacin.

  • Pediatric: There is no data related to Moxifloxacin in younger patients under 18 years of age.

  • Gender: The studies performed on males and females with the same dosage levels showed no unchanged results. So, no dosage adjustments are made based on gender.

  • Race: There was no change in results in different races using Moxifloxacin.

  • Renal Insufficiency: No dosage adjustments were required in patients dealing with renal insufficiency.

  • Hepatic Insufficiency: There are no dosage adjustments required in hepatic impairment patients.

Drug Interactions:

  • Antacids, if co-administered with Moxifloxacin, it reduces their bioavailability.

  • Drugs like Digoxin, Calcium, Itraconazole, Morphine, Probenecid, Ranitidine, Theophylline, Cyclosporine, and Warfarin do not affect the Moxifloxacin pharmacokinetics.

  • Atenolol, Digoxin, Glyburide, Itraconazole, oral contraceptives, Theophylline, and Cyclosporine have a chance to increase the effects of the anticoagulant.

Microbiology:

  • Mechanism of Action: The actions of Moxifloxacin is bactericidal. It inhibits the topoisomerase II and topoisomerase IV, which are required in DNA replication and transcription.

  • Mechanism of Resistance: Fluoroquinolones show resistance by mutating topoisomerase II genes, decreasing the outer membrane permeability.

  • Gram-Positive Bacteria: Moxifloxacin is active against bacteria. Enterococcus faecalis, Staphylococcus aureus, Streptococcus anginosus, Streptococcus constellatus, Streptococcus pneumoniae, and Streptococcus pyogenes.

  • Gram-Negative Bacteria: Enterobacter cloace, Escherichia coli, Haemophilis influenzae, Haemophilus parinfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Proteus mirabilis, Yersinia pestis.

  • Anaerobic Bacteria: Bacteroides fragilis, Bacteroides thetaiatamicron, Clostridium perfringens, Peptostreptococcus species.

  • Other Microorganisms: Chlamydophila pneumoniae and Mycoplasma pneumoniae.

Nonclinical Toxicology:

  • Carcinogenesis: The studies performed on animals have shown no carcinogenic results.

  • Mutagenesis: Studies have been performed regarding Moxifloxacin, but there is no evidence of mutation.

  • Impairment of Fertility: The studies performed on rates have provided no evidence or changes in the fertility rates of male and female rats.

Clinical Studies:

  • Acute Bacterial Sinusitis: A double-blind study was held in the US with Moxifloxacin 400 mg taken once daily for ten days, compared to Cefuroxime axetil, given 250 mg twice daily for ten days. It has 457 patients, where 90 % were cured with Moxifloxacin and 89% with Cefuroxime axetil. It proves to be a clinical success. Another study was performed where 336 patients were gone for antral puncture as Moxifloxacin was given 400 mg once daily. It was also successful, as 97% of Streptococcus pneumoniae, 83% of Moraxella catarrhalis, and 80% of Haemophilus influenzae were eradicated.

  • Acute Bacterial Exacerbation of Chronic Bronchitis: Randomized, double-blind studies were performed in the US with 629 patients. The patient was given Moxifloxacin 400 mg once daily for five days compared to Clarithromycin 500 mg twice daily for ten days. It was also proved to be a clinical success, as both were having 89 % success rate. The microbes that Moxifloxacin eradicated were Streptococcus (100%), Haemophilus influenzae (89%), Haemophilus parainfluenza (100%), Moraxella catarrhalis (85%), Staphylococcus aureus (94%), and Klebsiella pneumoniae (85%).

  • Community-Acquired Pneumonia: Randomized, double-blind study in the US has performed with Moxifloxacin 400 mg once daily compared to Clarithromycin 500 mg given twice daily to 475 patients, which proved to be a success with 95% of patients cured from both Clarithromycin and Moxifloxacin. Another random study with Moxifloxacin 400 mg and oral Fluoroquinolones in comparison were taken among 516 patients. This study provided 86% results with Moxifloxacin and 89% results with Fluoroquinolones.

  • In another study, 628 patients were held with Moxifloxacin in comparison to Amoxicillin/Clavulanate 625 mg given eight hours with or without Clarithromycin 500 mg twice daily. It was proved to be a success, with 93 % showing Moxifloxcin results and 84% showing Amoxicillin/Clavulanate with or without Clarithromycin. The microbes it eradicated are Streptococcus pneumoniae (94%), Staphylococcus aureus (85%), klebsiella pneumoniae (92%); Haemophilus influenzae (92%), Chlamydophila pneumoniae 93%; Mycoplasma pneumoniae (96%); Moraxella catarrhalis (92%).

  • Uncomplicated Skin and Skin Structure Infections: A random, double-blind study with Moxifloxacin 400 mg once daily for seven days compared to Cephalexin HCl 500 mg given three times a day for seven days the clinical success of 89% with Moxifloxacin and 91 % with Cephalexin HCl.

  • Complicated Skin and Skin Structure Infections: The double-blind study was performed with Moxifloxacin 400 mg once a day for seven days in comparison to beta-lactamase inhibitors with 617 patients with only 335 valid efficacy.

  • In another study with 804 patients, 55 % were treated with Moxifloxacin, and 53 % were with other comparators. Again, it showed overall clinical success.

  • Complicated Intra-Abdominal Infections: The randomized, double-blind study was performed with Moxifloxacin 400 mg given once a day for 5 to 14 days in comparison to Tazobactam. Six hundred eighty-one enrolled, but 379 were clinically analyzed.

  • Another study with Moxifloxacin and intravenous Ceftriaxone with Metronidazole followed by Amoxicillin/Clavulanate was given for 5 to 14 days. Five hundred ninety-five were enrolled, but 511 were evaluated. It has proved to be successful.

  • Plague: A randomized study was performed, which was blinded, placebo-controlled, but performed in African monkeys strained with Y.pestis. Ten males and ten females were given Moxifloxacin or a placebo. Ten were for placebo and 10 for Moxifloxacin. The Moxifloxacin-treated monkey survived for 30 days after the treatment. The success of the placebo was lower as compared to Moxifloxacin. The mean plasma concentration of the Moxifloxacin has shown significant improvement.

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Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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