Moxifloxacin

C difficile risk
High
Oral Bioavailability
Excellent

Dosing

400 mg IV/PO daily

General Information

  • Pneumonia including CAP, HAP, aspiration

  • Some intra-abdominal infections

  • CNS infection

  • Does not treat UTIs

  • As per all fluoroquinolones, use should be reserved for when alternatives are not available for use.

Pregnancy: Moxifloxacin crosses the placenta. There is very limited data on moxifloxacin use during pregnancy. In general, fluoroquinolone use during pregnancy has not been associated with congenital malformations or evidence of cartilage damage or tendon rupture in newborns. Fluoroquinolones and their effect on joint development are still being studied.
Fluoroquinolones should only be used during pregnancy in the absence of other alternatives to treat the infection.

Breastfeeding: No data is available for moxifloxacin in breastfeeding. It may be preferable to use an alternative until safety information is available. If a fluoroquinolone is required, an alternative fluoroquinolone with more information may be preferable (see ciprofloxacin or levofloxacin depending on indication).

Monitor QTc in patients with increased risk.

  • QTc prolongation

  • Dysglycemia

  • CNS toxicity including confusion, psychosis

  • Tendinopathy and rupture

  • GI upset

  • Weakness exacerbation in myasthenia gravis

  • Rash

  • QTc prolongation - Increased risk with other agents that prolong QTc

  • Divalent cations including Ca, Mg - decreased absorption

  • Warfarin - increased INR

  • Rifampin - decreases moxifloxacin levels

  • Concurrent use of steroids may increase the risk of tendon rupture for patients at risk

Does not treat urinary tract infections.

FDA Black Box warning against use in acute bacterial sinusitis, and acute exacerbation of chronic bronchitis where alternatives exist due to serious adverse side effects.

May exacerbate muscle weakness in persons with myasthenia gravis. Avoid Use.

Antimicrobial class: Fluoroquinolone.