Moxifloxacin

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[edit] BRAND NAMES

[edit] STRUCTURE

Moxifloxacin.jpg

[edit] MECHANISM OF ACTION

Moxifloxacin is a broad-spectrum bactericidal agents of the fluoroquinolone class (Moxifloxacin is a 4th generation quinolone) with a wide range activity against gram-negative and gram-positive organisms.

Moxifloxacin inhibits bacterial enzymes DNA gyrase and topoisomerase IV. DNA gyrase catalyzes the negative supercoiling of the circular DNA found in bacteria and Topoisomerase IV, on the other hand, is involved in the separation process of the DNA daughter chains after bacterial DNA duplication.

Depending on the type of bacterium, these enzymes represent either the primary or secondary target of antimicrobial action. In Gram-negative bacteria, such as E.coli, fluoroquinolones predominantly inhibit DNA gyrase, whereas for Gram-positive organisms like Staph.aureus, Topoisomerase IV is the principle target.

Ultimately, the action of Moxifloxacin on DNA gyrase or on topoisomerase IV, results in damage to bacterial DNA and bacterial cell death.

[edit] INDICATIONS

Infections caused by bacteria susceptible to Moxifloxacin in Adults ≥ 18 years old of age:

  • Acute Bacterial Sinusitis
  • Acute Bacterial Exacerbation of Chronic Bronchitis
  • Community Acquired Pneumonia
  • Skin and Skin Structure Infections: Uncomplicated and Complicated
  • Complicated Intra-Abdominal Infections

[edit] DOSAGE

Oral tablets: Moxifloxacin is given only once a day

Type of Infection Dose every

24 hours

Duration

(days)

Community Acquired Pneumonia 400 mg 7-14
Acute Bacterial Sinusitis 400 mg 10
Acute Bacterial Exacerbation of Chronic Bronchitis 400 mg 5
Complicated Skin and Skin Structure Infections (SSSI) 400 mg 7–21
Uncomplicated SSSI 400 mg 7
Complicated Intra-Abdominal Infections 400 mg 5-14

No dosage adjustment in patients with renal or hepatic impairment

[edit] CONTRAINDICATIONS

  • Known hypersensitivity to Moxifloxacin or to other quinolones
  • Patients who are pregnant or lactating
  • Patients below 18 years of age

[edit] WARNINGS AND PRECAUTIONS

  • Tendinitis may rarely occur. It most frequently involves the Achilles tendon and may lead to tendon rupture. This risk is further increased in older patients usually over 60 years of age, in patients taking corticosteroids and in patients with kidney, heart or lung transplants. Discontinue if pain or inflammation in a tendon occurs
  • Hypersensitivity reactions: Anaphylactic reactions and allergic skin reactions, serious, occasionally fatal, may occur after first dose or subsequent doses.
  • Central nervous system (CNS) events including dizziness, confusion, hallucination, depression, and rarely suicidal thoughts or acts may occur after first dose. Use caution in patients with known or suspected CNS disorders that may predispose to seizures or lower the seizure threshold (Quinolones may lower the seizure threshold and may trigger seizures).
  • Clostridium difficile-associated colitis: evaluate if diarrhea, particularly if severe, persistent and/or bloody, during or after treatment with Moxifloxacin.
  • Quinolones may lower the seizure threshold and may trigger seizures. Levofloxacin is contraindicated in patients with a history of epilepsy.
  • Peripheral neuropathy (Rare cases): discontinue if symptoms occur in order to prevent irreversibility (symptoms of neuropathy include pain, burning, tingling, numbness, and/or weakness or other alterations of sensation including light touch, pain, temperature, position sense, and vibratory sensation)

[edit] INTERACTIONS

  • Multivalent cation containing products including iron salts, zinc salts, magnesium or aluminium-containing antacids and Sucralfate decrease the absorption of Moxifloxacin. These products or drugs should not be taken 4 hours before or 8 hours after Moxifloxacin tablet administration.
  • Vitamin K antagonists (Warfarin): Effect may be enhanced. Monitor prothrombin time, INR, watch for bleeding.
  • Class IA (Disopyramide, Procainamide) and Class III (Sotalol, Amiodarone, Dronedarone, Ibutilide) antiarrhythmics: Proarrhythmic effect may be enhanced. Avoid concomitant use.

[edit] PREGNANCY AND LACTATION

  • Pregnancy Category C (US). Moxifloxacin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
  • Nursing mothers: Moxifloxacin is excreted in the breast milk of rats. Moxifloxacin may also be excreted in human milk. Because of the potential for serious adverse reactions in infants who are nursing from mothers taking Moxifloxacin, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

[edit] SIDE EFFECTS

Most common reactions (≥3%): Nausea, diarrhea, headache, and dizziness

[edit] RELATED LINKS

[edit] BIBLIOGRAPHY

[edit] REFERENCES