MOXIFLOXACIN HYDROCHLORIDE

MOXIFLOXACIN HYDROCHLORIDE
(mox-i-flox'a-sin)
Avelox, Vigamox
Classifications: antibiotic; quinolone;
Therapeutic: antibiotic; quinolone

Prototype: Ciprofloxacin
Pregnancy Category: C

Availability

400 mg tablets; 0.5% ophthalmic solution; 160 mg/100 mL infusion

Action

Moxifloxacin is a synthetic broad-spectrum antibiotic belonging to the fluoroquinolone class of drugs. It inhibits DNa gyrase, an enzyme required for DNA replication, transcription, repair, and recombination of bacterial DNA.

Therapeutic Effect

Broad spectrum antibiotic that is bactericidal against gram-positive and gram-negative organisms.

Uses

Treatment of acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, community-acquired pneumonia, skin and skin structure infections, bacterial conjunctivitis, complicated skin infections.

Contraindications

Hypersensitivity to moxifloxacin or other quinolones; moderate to severe hepatic insufficiency; syphilis; patients with history of prolonged QTc interval on ECG, history of ventricular arrhythmias, atrial fibrillation, hypokalemia, bradycardia, acute myocardial ischemia, acute MI, patients receiving Class Ia or Class III antiarrhythmic drugs; tendon pain; viral infection; torsades de pointes; pregnancy (category C); lactation; ocular preparation use in children <1 y.

Cautious Use

CNS disorders; cerebrovascular disease, colitis, diarrhea, GI disease; diabetes mellitus; mild or moderate heart insufficiency; myasthenia gravis; seizure disorder; sunlight (UV) exposure.

Route & Dosage

Acute Bacterial Sinusitis, Acute Bacterial Exacerbation of Chronic Bronchitis, Community-Acquired Pneumonia, Skin Infections
Adult: PO/IV 400 mg q.d. x 5–14 d

Complicated Skin Infection
Adult: PO/IV 400 mg q.d. x 7–21 d

Bacterial Conjunctivitis
Adult/Child (>1 y): Ophthalmic 1 drop in affected eye(s) t.i.d. x 7 d

Administration

  • Note: Do not administer to persons with QTc prolongation, hypokalemia, or those receiving Class IA or Class III antiarrhythmic drugs.
Intravenous

PREPARE: IV Infusion: Avelox (400 mg) is supplied in ready-to-use 250 mL IV bags. No further dilution is necessary.  

ADMINISTER: IV Infusion: Give over 60 min. AVOID RAPID OR BOLUS DOSE.  

Oral
  • Administer at least 4 h before or 8 h after multivitamins containing iron or zinc, or antacids containing magnesium, calcium, aluminum, or sucralfate.
  • Store at 15°–30° C (59°–86° F); protect from high humidity.

Adverse Effects (≥1%)

CNS: Dizziness, headache, peripheral neuropathy. GI: Nausea, diarrhea, abdominal pain, vomiting, taste perversion, abnormal liver function tests, dyspepsia. Musculoskeletal: Tendon rupture, cartilage erosion.

Diagnostic Test Interference

May cause false positive on opiate screening tests.

Interactions

Drug: Iron, zinc, antacids, aluminum, magnesium, calcium, sucralfate decrease absorption; atenolol, erythromycin, antipsychotics, tricyclic antidepressants, quinidine, procainamide, amiodarone, sotalol may cause prolonged QTc interval.

Pharmacokinetics

Absorption: 90% bioavailable. Steady State: 3 d. Distribution: 50% protein bound. Metabolism: In liver. Elimination: Unchanged drug: 20% in urine, 25% in feces; metabolites: 38% in feces, 14% in urine. Half-Life: 12 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor therapeutic effectiveness indicated by clinical improvement of infection.
  • Monitor for and notify physician immediately of adverse CNS effects.
  • Notify physician immediately for S&S of hypersensitivity (see Appendix F).
  • Lab tests: C&S before initiation of therapy and baseline serum potassium with history of hypokalemia.

Patient & Family Education

  • Exercise care in timing of consumption of vitamins and antacids (see ADMINISTRATION).
  • Drink fluids liberally, unless directed otherwise.
  • Increased seizure potential is possible, especially when history of seizure exists.
  • Stop taking drug and notify physician if experiencing palpitations, fainting, skin rash, severe diarrhea, ankle/foot pain, agitation, insomnia.
  • Avoid engaging in hazardous activities until reaction to drug is known.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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